周邊動脈疾病：神經與血管之研究

Studies on Peripheral Nerves and Vasculatures in Peripheral Artery Disease

薛學文(Hsueh-Wen hsueh)

指導教授 ： 謝松蒼

國立臺灣大學/醫學院/臨床醫學研究所/碩士(2019年)

https://doi.org/10.6342/NTU201902740

摘要

背景：周邊動脈疾病是一種常見疾病，在一般人群中的盛行率為3-10％。它降低了功能和生活品質。間歇性跛行是周邊動脈疾病最著名的症狀，但只有10~20％的患者出現這種症狀。更多患者則表現非典型症狀或無症狀。血流變化和臨床症狀的關聯性不好，也表明周邊動脈疾病潛在的其他機制的可能性。 周邊動脈疾病相關的神經病變是一種可能的機制，但過去研究較少。本研究將通過結合各項檢查及問卷探討周邊動脈疾病相關的神經病變之發病機制和神經損傷變化。
方法：年齡在20歲以下，低於90歲，通過電腦斷層血管造影或血管攝影診斷為PAD的患者將參加本研究。我們將收集臨床分期、生活品質和步行能力的問卷調查、神經傳導檢查和神經/血管超音波檢查。將對（1）周邊動脈疾病和正常組之間的比較和（2）每個參數之間的相關性進行分析。
結果：我們招募了19名患者（平均年齡：69.9±8.9歲;男性: 11位）以進行進一步分析。在所有患者中，12名（63.2％）患者患有糖尿病，13名患者（68.4％）患有高脂血症。生活品質與Fontaine分期有相關。神經傳導檢查的異常率為85.7％。脛骨和腓神經的複合運動動作電位與Fontane分期，生活品質問卷和行走損傷問卷相關。 周邊動脈疾病組與正常組的橫截面積和神經高度指數相似。 周邊動脈疾病組和對照組之間手指動脈的阻力指數，近端足部的峰值收縮速度，遠端足的峰值收縮速度和遠端足的平均速度都有顯著差異。然而，只有遠端足的峰值收縮速度與Fontane分期，生活品質問卷和行走損傷問卷相關性良好。然而，超音波和神經傳導檢查之間沒有顯著的相關性。
結論：這項研究表明，神經傳導檢查和足步遠端動脈的流速可以反映周邊動脈疾病的嚴重程度。然而，遠端動脈和神經之間的相互作用需要進一步研究。

關鍵字

周邊動脈疾病 ； 神經病變 ； 超音波 ； 都普勒檢查 ； Fontaine分期

並列摘要

Background: Peripheral artery disease (PAD) is a common disorder, affecting 3-10% in general population. It impaired the functional capacity and the quality of life. Intermittent claudication is the most famous symptoms of PAD, but there were only 10~20% patients with PAD presented this pathognomonic symptom. More patients present atypical symptoms or are asymptomatic. The discrepancy of the blood flow change and functional capacity also indicates the possibility of other mechanisms underlying the PAD. PAD-related neuropathy is one possible mechanism, but less investigated in the past. This study would explore the PAD-related neuropathy pathogenesis and the nerve damage change with the integrated examinations.
Methods: Patients, aged at least 20 years old, below the 90 years old, with diagnosis of PAD by the computed topography angiography or digital substraction angiography would be enrolled in this study. The data of clinical stage, questionaaires for quality of life (QOL) and walking ability, nerve conduction studies and nerve/vascular sonography would be collected. The analysis would be performed for (1)the comparison between the PAD and normal groups and (2) correlation between each parameters.
Results: Nineteen patients (mean age: 69.9 ± 8.9 years; male) were recruited for further analysis. Among all patients, 12 (63.2%) patients had diabetes mellitus, and 13 (68.4%) patients had hyperlipidemia. The questionnaires of quality of life were correlated to the Fontaine stage. The abnormality rate of nerve conduction study swas 85.7%. The compound motor action ptoential of tibial and peroneal nerve correlated to the Fontane stage, QOL, and walking impairment questionnaire. The cross sectional area and nerve height index were similar between the PAD group and normal group. The resistance index of the finger digital artery, peak systolic velocity of the proximal foot, peak systolic velocity of the distal foot, and mean velocity of the distal foot were siginifcantly different between the PAD and control groups. However, only the PSV of the distal foot correlated well to the Fontane stage, questionnaire of QOL, and walking impairment questionnaire. However, no significant correlation was noted between the ultrasound and nerve conduction studies.
Conclusion: This study showed the nerve conduction study and the flow velocity of the very distal artery of the foot could reflect the severity of PAD. However, the interaction between the very distal artery and nerve needs further study.

並列關鍵字

Peripheral artery disease ； neuropathy ； ultrasound ； duplex ； Fontaine stage

參考文獻

Aboyans, V., J. B. Ricco, M. E. L. Bartelink, et al. (2017). "2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)." Eur Heart J 39(9): 763-816.

Angus-Leppan, H. and D. Burke (1992). "The function of large and small nerve fibers in renal failure." Muscle Nerve 15(3): 288-294.

Argyriou, A. A., I. Tsolakis, S. Papadoulas, et al. (2006). "Sympathetic skin response in patients with peripheral arterial occlusive disease." Clin Neurophysiol 117(2): 414-419.

Aschwanden, M., S. Partovi, B. Jacobi, et al. (2014). "Assessing the end-organ in peripheral arterial occlusive disease-from contrast-enhanced ultrasound to blood-oxygen-level-dependent MR imaging." Cardiovasc Diagn Ther 4(2): 165-172.

Baumer, P., H. Kele, A. Xia, et al. (2016). "Posterior interosseous neuropathy: Supinator syndrome vs fascicular radial neuropathy." Neurology 87(18): 1884-1891.