背景資料
周邊血管疾病，在各種階段的慢性腎臟疾病之病患中，是一種相當常見的疾病且其也增加此類病人的心血管疾病的合併症及死亡率。然而、對於接受腎臟移植的病患，有關此疾病的盛行率和相關危險因子的研究至今仍然相當有限。本研究的目的就是希望能在腎臟移植病患臨床照護中，能提早診斷周邊血管疾病及了解相關的危險因子，以期能改善此類病患的治療及預後。
研究材料及方法
本研究是針對在中山醫學大學規則追蹤的腎臟移植病患的一個橫斷式研究 (Cross-Sectional Study)。此研究收入對象為未有周邊血管疾病病史的腎臟移植的病患。我們利用腳踝-手臂血壓指數(Ankle-Brachial Index, ABI)當作診斷周邊血管疾病的一個指標。當病人的ABI指標小於0.9時，診斷其為亞臨床周邊血管疾病的患者。主要研究內容為是腎臟移植病患的亞臨床周邊血管疾病的盛行率和相關危險因子。另外本研究也試著看手臂-腳踝脈搏傳導速率(BaPWV)及高敏感度 C-反應蛋白 (hs-CRP)跟ABI數值的相關性
結果
共有304位患者成功完成本研究。其平均年齡是53歲，且其中共有30個病人(9.9%)有非周邊血管的動脈粥狀硬化的病史。在這304位患者中，有25位(8%)的ABI小於0.9及 一位(0.3%)的ABI大於1.3。相較於有正常ABI的腎移植病患，過去有動脈粥狀硬化的病史是唯一獨立的危險因子來預測病人有周邊血管疾病。另一方面，我們並沒有發現手臂-腳踝脈搏傳導速率(BaPWV)及高敏感度 C-反應蛋白 (hs-CRP)跟ABI數值有統計學上的相關性。
結論
對於腎臟移植病患來說，周邊血管疾病是一個不少見但卻少被探討的問題。我們發現過去有動脈粥狀硬化病史的腎移植患者統計上有意義的增加罹患周邊血管疾病的機會。然而，周邊血管疾病對於腎臟移植患者的長期預後的影響及其最佳的治療則需進一步的研究。
Background Peripheral arterial disease (PAD) is a common finding in patients at various stages of chronic kidney disease and is associated with higher cardiovascular morbidity and mortality; however, there has only been a limited amount of data that have been published regarding the prevalence and associated risk factors of subclinical PAD in renal transplant recipients.
Methods The authors cross sectionally investigated the prevalence of PAD using ankle-brachial index (ABI) in 304 renal transplant recipients with no previous diagnosis of PAD. Patients were considered to have subclinical PAD when ABI < 0.9. The authors also determined the associated risk factors for subclinical PAD and the relationship between the level of ABI and BaPWV.
Results The mean age of the 304 patients was 53 years, and 30 patients (9.9%) had a history of atherosclerotic event (including past cardiovascular and cerebrovascular events). Twenty-five of the 304 patients (8%) had ABI < 0.9 and 1 had (0.3%) ABI > 1.3. Compared to patients with normal ABI, a history of atherosclerotic events is the only independent risk factor for patients with subclinical PAD (P= 0.0468). There was no difference in the level of BaPWV between patients with normal ABI and ABI< 0.9 (P= 0.8538)
Conclusions Subclinical PAD is an inadvertent issue in renal transplant patients, especially those with a history of atherosclerotic events. Further research is needed on the long-term clinical impact and optimal treatment of subclinical PAD among renal transplant patients.
