末期腎病變患者的下肢周邊動脈血管疾病：文獻回顧

Lower Extremity Peripheral Artery Disease in End-stage Renal Disease: A Literature Review

顏正杰(Cheng-Chieh Yen) ； 邱怡文(Yi-Wen Chiu) ； 陳鴻鈞(Hung-Chun Chen)

《內科學誌》 27卷2期 (2016/04) Pp. 68-78

https://doi.org/10.6314/JIMT.2016.27(2).03

摘要

末期腎病變患者由於兼具心血管傳統危險因子和非傳統危險因子，故罹患周邊血管疾病的比例高於一般族群。臨床表現主要可以分為非危急缺血現象和危急缺血現象兩大類，且糖尿病患者的症狀通常較為嚴重。周邊血管疾病的診斷，在末期腎病變患者較一般族群更具挑戰性。非侵入性診斷工具中，踝肱指數操作容易，但受到血管鈣化影響故特異度不高，趾肱指數則較不影響。肱踝脈波傳導速率的測量，則可以用來篩檢疑似踝肱指數偽陰性的患者。侵入性診斷工具中，血管攝影是周邊血管疾病的標準診斷工具，其他如血管內超音波、多偵測器電腦斷層血管攝影、磁振周邊血管攝影或二氧化碳血管攝影的診斷率皆不錯，但也有各自的限制且缺乏末期腎病變患者的相關研究。非危急缺血現象的周邊血管疾病的患者其治療包括危險因子控制、運動、足部照護、藥物和低密度脂蛋白分離術等；危急缺血現象的治療包括血栓溶解、經皮動脈血管擴張術、外科血管重建和截肢等。末期腎病變患者一旦確診罹患周邊血管疾病，無論經由何種治療方式預後都相當不好。未來可以朝向基因或病理機轉等層面，重新探討解決的方法。

關鍵字

周邊血管疾病 ； 末期腎病變 ； 危急缺血現象

並列摘要

Peripheral artery disease are more prevalent in end stage renal disease patients than the general due to suffering from both traditional and nontraditional cardiovascular risk factors. Clinical manifestations can be divided into noncritical ischemia(such as intermittent claudication) and critical ischemia(such as resting pain or gangrene). It is a challenge to diagnose peripheral artery disease among end stage renal disease patients. In noninvasive diagnostic tools, ankle brachial index is easy to perform but has poor specificity, toe brachial index is not affected by vessel calcification and brachial ankle pulse wave velocity can screen those with normal ankle brachial index; as to invasive diagnostic tools, contrast arteriography is the gold standard of diagnosis of peripheral artery disease, other tools such as intravascular ultrasonography, multi-detector computed tomography angiography, peripheral magnetic resonance angiography and Carbon dioxide angiography are practical but have its own limitations and lack of evidence among this population. Therapy of noncritical ischemia includes risk factor reduction, exercise, foot care, medication and low-density lipoprotein apheresis; therapy of critical ischemia includes thrombolysis, percutaneous transluminal angioplasty, surgical revascularization and amputation. The prognosis of end stage renal disease patients is still poor nowadays regardless of contemporary therapeutic modalities. Further investigation is needed for risk factors identification, diagnostic tool selection, preventive strategies and therapeutic algorithms establishment in earlier stages of chronic kidney disease.

並列關鍵字

Peripheral artery disease ； End stage renal disease ； Critical ischemia