作者：Allison Gandey 齣處：WebMD醫學新聞 　　August 27, 2009 — 並非所有病患都會顯示周邊動脈疾病的徵兆與癥狀 研究者建議 無癥狀的周邊動脈疾病對中風存活者來說是個風險 - 趣味新聞網

發表日期 2009-09-13T08:30:24+08:00

     本帖最後由 lsc0019 於 2009-9-17 23:38 編輯

作者：Allison Gandey
齣處：WebMD醫學新聞

August 27, 2009 — 並非所有病患都會顯示周邊動脈疾病的徵兆與癥狀，研究者建議，中風存活者以及有暫時性缺血性發作病史者，風險更大。中風(Stroke)期刊於綫上先行發錶的報告中，研究者呼籲對那些有血管事件風險者進行更多踝肱檢測(ankle-brachial testing)。

北卡羅來納大學中風中心的Souvik Sen醫師等研究者報告指齣，其研究顯示，將近四分之一的腦血管疾病病患有異常的踝肱指數，錶示這些人有較高的緻命和非緻命心血管事件風險。該研究接受Bristol-Myers Squibb和Sanofi Pharmaceuticals藥廠支持。

美國預防服務任務小組目前建議不用對一般人進行篩檢，因為周邊動脈疾病的發生率低，而且僞陽性結果反而會造成傷害。不過，美國心髒協會和美國心髒科學院發錶的處置指引，建議對所有高風險病患進行篩檢。

【篩檢高風險病患】
在這篇前瞻縱嚮醫院基礎研究中，研究對象有102名病患。他們評估研究對象的中風風險因素、踝肱指數、檢驗參數。研究者之後追蹤病患的綜閤血管事件兩年。

研究者發現，26%的病患屬於無癥狀的周邊動脈疾病，後續心血管事件的機率達三倍。無癥狀的周邊動脈疾病患者有半數在後來發生事件，無此疾病者隻有16%發生。

Sen醫師與其團隊指齣，他們的研究樣本少，呼籲進行其他研究探討他們提齣的問題。他們指齣，需要後續研究以確認篩檢高風險病患是否可受益於積極的監控與風險因素調整。

Sen醫師在與該研究有關的新聞稿中錶示，這項檢測隻要15分鍾不到，很容易在診間內或病床邊進行。

【許多病患未曾注意腳痛】
調查顯示，多達三分之一的病患未曾嚮醫師提及他們身體動作時的腳痛、抽筋、虛弱、以及跛行，據估計，不到半數一般執業醫師會固定詢問病患這些癥狀。

另一篇由Sanofi藥廠支持、發錶於5月心髒血管介入與導管期刊(Catheterization and Cardiovascular Interventions)的研究中，研究者指齣，周邊動脈疾病通常被已知有缺血性心髒疾病、正接受心血管專傢照護的病患忽視。

紐約市Weill Cornell醫學院的Issam Moussa醫師領導的研究團隊，研究瞭800名轉診進行冠狀動脈血管攝影的病患。如同之前由Medscape Neurology報導的，15%的病患有周邊動脈疾病，但之前沒有診斷。

目前的指引建議，踝肱指數小於0.9就有問題。不過，發錶於3月美國心髒病學院期刊(Journal of the American College of Cardiology)的一篇研究中，研究者認為，前述的切點仍得商確，應調整到小於1.0就有問題(2009; 53:1056–1062)。

伊利諾州芝加哥西北大學的Mary McDermott醫師等人指齣，真正正常的指數大約為1.08，所以如果是小於1.00，已經可說是異常或是正常值的下限。

Bristol-Myers Squibb以及Sanofi Pharmaceuticals藥廠支持本研究。Souvik Sen醫師擔任這兩傢藥廠的發言人。

Stroke. 綫上發錶於2009年8月27日。

Asymptomatic Peripheral Artery Disease Risky for Stroke Survivors

By Allison Gandey
Medscape Medical News

August 27, 2009 — Not all patients will show signs and symptoms of peripheral artery disease, and investigators are suggesting that stroke survivors and those with a history of transient ischemic attack are at heightened risk. Reporting in an early online release from the journal Stroke, researchers call for more ankle-brachial testing in those at risk for vascular events.

"Our study showed that an abnormal ankle-brachial index is prevalent in approximately one fourth of the patients with cerebrovascular disease and identifies a population at high risk of fatal and nonfatal cardiovascular events," report investigators led by Souvik Sen, MD, from the University of North Carolina Stroke Center at Chapel Hill. The study was supported by Bristol-Myers Squibb and Sanofi Pharmaceuticals.

The US Preventive Services Task Force currently recommends against screening in the general population because of the low prevalence of peripheral artery disease and possible harm posed by false-positive results. However, management guidelines developed by the American Heart Association and the American College of Cardiology recommend screening all high-risk patients.

Screen High-Risk Patients

In this prospective longitudinal hospital-based study, investigators looked at 102 patients. They assessed participants for stroke risk factors, ankle-brachial index, and laboratory parameters. Researchers then followed up patients for 2 years for composite vascular events.

Investigators found that 26% of the patients had asymptomatic peripheral artery disease and had 3 times more subsequent cardiovascular events. Half of the patients with asymptomatic peripheral artery disease had subsequent events compared with just 16% of those without disease.

Dr. Sen and his team point to the small sample size of their study and call for additional work exploring the questions raised in their article. Further studies are needed to determine whether the screened high-risk patients may benefit from aggressive monitoring and risk factor modifications, they note.

In a news release about the new study, Dr. Sen said, "The test is easily performed in less than 15 minutes at the physician's office or at bed-side in hospitalized patients."

Many Patients Never Mention Leg Pain

Surveys show that up to one third of patients never tell their physician about leg pain, cramping, weakness, and limping during physical exertion, and it is estimated that fewer than half of all general practitioners routinely ask about these symptoms.

In another study supported by Sanofi and published in the May issue of Catheterization and Cardiovascular Interventions, researchers showed that peripheral artery disease is often overlooked in patients with known ischemic heart disease who are under specialist cardiovascular care.

The team, led by Issam Moussa, MD, from Weill Cornell Medical College in New York City, studied 800 patients referred for coronary angiography. As previously reported by Medscape Neurology, 15% of the patients had peripheral artery disease despite no previous diagnosis.

Current guidelines suggest that an ankle-brachial index of less than 0.9 is problematic. However, in a study published in March in the Journal of the American College of Cardiology, investigators suggested that the cut point should be even more cautious and be moved to less than 1.0 (2009; 53:1056–1062).

Investigators led by Mary McDermott, MD, from Northwestern University in Chicago, Illinois, point out that a truly normal index is about 1.08, so if it is less than 1.00, it is already getting into the abnormal or low range.

This study was supported by Bristol-Myers Squibb and Sanofi Pharmaceuticals. Dr. Souvik Sen serves on the speaker's bureau for the companies.

Stroke. Published online August 27, 2009.

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