外科的下肢血行再建術後の透析患者の死亡/下肢切断リスクスコア：歩行能力を考慮した検討
下肢動脈血行再建術は重症下肢虚血を呈する症例を対象に，下肢切断を回避し，下肢機能を維持することを目的に行われる。PREVENT III risk scoreは術後重症虚血肢症例の予後予測に役立つが，透析4点，組織欠損3点であり，足部に潰瘍を有する透析患者は，高リスク群に分類されてしまうため，下肢切断/死亡リスクを詳細に見積もることが困難である。そこで本研究では，重症下肢虚血に対し血行再建術が施行された213名の透析患者を対象に調査を行い，リスクスコア（Prognosis Amputation or Death for HD patient risk score［PAD for HD risk...
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| Published in | 脈管学 Vol. 56; no. 7; pp. 85 - 91 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本脈管学会
2016
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0387-1126 1880-8840 |
| DOI | 10.7133/jca.15-00012 |
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| Abstract | 下肢動脈血行再建術は重症下肢虚血を呈する症例を対象に，下肢切断を回避し，下肢機能を維持することを目的に行われる。PREVENT III risk scoreは術後重症虚血肢症例の予後予測に役立つが，透析4点，組織欠損3点であり，足部に潰瘍を有する透析患者は，高リスク群に分類されてしまうため，下肢切断/死亡リスクを詳細に見積もることが困難である。そこで本研究では，重症下肢虚血に対し血行再建術が施行された213名の透析患者を対象に調査を行い，リスクスコア（Prognosis Amputation or Death for HD patient risk score［PAD for HD risk score］）を作成した。PAD for HD risk score（術後歩行非自立 3点，GNRI 92未満 2点，潰瘍形成/壊死 2点，CRP 0.3 mg/dl未満1点，75歳以上1点）のArea under the curve（AUC）は0.79（95％ confidence interval〔CI〕: 0.71–0.87）でありPREVENT III risk score（AUC: 0.63, 95％CI: 0.56–0.71）よりも有意に予測能が高いことが確認された（p<0.01）。また，スコアの合計点を算出し，昇順に3群に分け比較した結果，各群間の術後1年後のAFS rateおよび，歩行自立率に有意差がみられた。これらのことから，本リスクスコアは術後リハビリテーションの目標設定をする際の一助となると考える。 |
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| AbstractList | 下肢動脈血行再建術は重症下肢虚血を呈する症例を対象に，下肢切断を回避し，下肢機能を維持することを目的に行われる。PREVENT III risk scoreは術後重症虚血肢症例の予後予測に役立つが，透析4点，組織欠損3点であり，足部に潰瘍を有する透析患者は，高リスク群に分類されてしまうため，下肢切断/死亡リスクを詳細に見積もることが困難である。そこで本研究では，重症下肢虚血に対し血行再建術が施行された213名の透析患者を対象に調査を行い，リスクスコア（Prognosis Amputation or Death for HD patient risk score［PAD for HD risk score］）を作成した。PAD for HD risk score（術後歩行非自立 3点，GNRI 92未満 2点，潰瘍形成/壊死 2点，CRP 0.3 mg/dl未満1点，75歳以上1点）のArea under the curve（AUC）は0.79（95％ confidence interval〔CI〕: 0.71–0.87）でありPREVENT III risk score（AUC: 0.63, 95％CI: 0.56–0.71）よりも有意に予測能が高いことが確認された（p<0.01）。また，スコアの合計点を算出し，昇順に3群に分け比較した結果，各群間の術後1年後のAFS rateおよび，歩行自立率に有意差がみられた。これらのことから，本リスクスコアは術後リハビリテーションの目標設定をする際の一助となると考える。 |
| Author | 伊藤, 真也 若井, 建志 山崎, 遥人 近藤, 恵理子 林, 久恵 佐々木, 綾菜 河村, 守雄 |
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| References | 3) Ishii H, Kumada Y, Toriyama T, et al: Prognostic values of C-reactive protein levels on clinical outcome after endovascular therapy in hemodialysis patients with peripheral artery disease. J Vasc Surg 2010; 52: 854–885 4) Schanzer A, Mega J, Meadows J, et al: Risk stratification in critical limb ischemia: derivation and validation of a model to predict amputation-free survival using multicenter surgical outcomes data. J Vasc Surg 2008; 48: 1464–1471 10) Logar CM, Pappas LM, Ramkumar N, et al: Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study. BMC Nephrol 2005; 6: 3 15) Goodney PP, Nolan BW, Schanzer A, et al: Factors associated with amputation or graft occlusion one year after lower extremity bypass in Northern New England. Ann Vasc Surg 2010; 24: 57–68 16) Hatakeyama S, Saito M, Ishigaki K, et al: Skin perfusion pressure is a prognostic factor in hemodialysis patient. Int J Nephrol 2012; Article ID 385274: 7 pages 6) Rollins KE, Coughlin PA: Functional outcomes following revascularisation for critical limb ischaemia. Eur J Vasc Endovasc Surg 2012; 43: 420–425 11) Cieri E, Lenti M, De Rango P, et al: Functional ability in patients with critical limb ischaemia is unaffected by successful revascularisation. Eur J Vasc Endovasc Surg 2011; 41: 256–263 1) Arvela E, Söderström M, Korhonen M, et al: Finnvasc score and modified Prevent III score predict long-term outcome after infrainguinal surgical and endovascular revascularization for critical limb ischemia. J Vasc Surg 2010; 52: 1218–1225 13) Combe C, Albert JM, Bragg-Gresham JL, et al: The burden of amputation among hemodialysis patients in the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis 2009; 54: 680–692 2) Söderström M, Arvela E, Aho PS, et al: High leg salvage rate after infrainguinal bypass surgery for ischemic tissue loss (Fontaine IV) is compromised by the short life expectancy. Scand J Surg 2010; 99: 230–234 7) Stenvinkel P, Heimbürger O, Paultre F, et al: Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 1999; 55: 1899–1911 8) Bouillanne O, Morineau G, Dupont C, et al: Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 2005; 82: 777–783 14) 熊田佳孝，古橋究一，杉本昌之，他：維持透析患者に対する下肢バイパス術の遠隔期成績．脈管学 2006; 46: 681–687 9) Granger CV, Hamilton BB, Keith RA, et al: Advances infunctional assessment for medical rehabilitation.Top Geri Rehabil 1986; 1: 59–74 12) Rajagopalan S, Dellegrottaglie S, Furniss AL, et al: Peripheral arterial disease in patients with end-stage renal disease observations from the dialysis outcomes and practice patterns study (DOPPS). Circulation 2006; 114: 1914–1922 5) Flu HC, Lardenoye JH, Veen EJ, et al: Functional status as a prognostic factor for primary revascularization for critical limb ischemia. J Vasc Surg 2010; 51: 360–371. e1 |
| References_xml | – reference: 11) Cieri E, Lenti M, De Rango P, et al: Functional ability in patients with critical limb ischaemia is unaffected by successful revascularisation. Eur J Vasc Endovasc Surg 2011; 41: 256–263 – reference: 4) Schanzer A, Mega J, Meadows J, et al: Risk stratification in critical limb ischemia: derivation and validation of a model to predict amputation-free survival using multicenter surgical outcomes data. J Vasc Surg 2008; 48: 1464–1471 – reference: 13) Combe C, Albert JM, Bragg-Gresham JL, et al: The burden of amputation among hemodialysis patients in the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis 2009; 54: 680–692 – reference: 14) 熊田佳孝，古橋究一，杉本昌之，他：維持透析患者に対する下肢バイパス術の遠隔期成績．脈管学 2006; 46: 681–687 – reference: 5) Flu HC, Lardenoye JH, Veen EJ, et al: Functional status as a prognostic factor for primary revascularization for critical limb ischemia. J Vasc Surg 2010; 51: 360–371. e1 – reference: 3) Ishii H, Kumada Y, Toriyama T, et al: Prognostic values of C-reactive protein levels on clinical outcome after endovascular therapy in hemodialysis patients with peripheral artery disease. J Vasc Surg 2010; 52: 854–885 – reference: 8) Bouillanne O, Morineau G, Dupont C, et al: Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 2005; 82: 777–783 – reference: 10) Logar CM, Pappas LM, Ramkumar N, et al: Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study. BMC Nephrol 2005; 6: 3 – reference: 16) Hatakeyama S, Saito M, Ishigaki K, et al: Skin perfusion pressure is a prognostic factor in hemodialysis patient. Int J Nephrol 2012; Article ID 385274: 7 pages – reference: 12) Rajagopalan S, Dellegrottaglie S, Furniss AL, et al: Peripheral arterial disease in patients with end-stage renal disease observations from the dialysis outcomes and practice patterns study (DOPPS). Circulation 2006; 114: 1914–1922 – reference: 1) Arvela E, Söderström M, Korhonen M, et al: Finnvasc score and modified Prevent III score predict long-term outcome after infrainguinal surgical and endovascular revascularization for critical limb ischemia. J Vasc Surg 2010; 52: 1218–1225 – reference: 6) Rollins KE, Coughlin PA: Functional outcomes following revascularisation for critical limb ischaemia. Eur J Vasc Endovasc Surg 2012; 43: 420–425 – reference: 15) Goodney PP, Nolan BW, Schanzer A, et al: Factors associated with amputation or graft occlusion one year after lower extremity bypass in Northern New England. Ann Vasc Surg 2010; 24: 57–68 – reference: 9) Granger CV, Hamilton BB, Keith RA, et al: Advances infunctional assessment for medical rehabilitation.Top Geri Rehabil 1986; 1: 59–74 – reference: 2) Söderström M, Arvela E, Aho PS, et al: High leg salvage rate after infrainguinal bypass surgery for ischemic tissue loss (Fontaine IV) is compromised by the short life expectancy. Scand J Surg 2010; 99: 230–234 – reference: 7) Stenvinkel P, Heimbürger O, Paultre F, et al: Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 1999; 55: 1899–1911 |
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| Snippet | 下肢動脈血行再建術は重症下肢虚血を呈する症例を対象に，下肢切断を回避し，下肢機能を維持することを目的に行われる。PREVENT III risk... |
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| SubjectTerms | critical limb ischemia dialysis multivariate analysis risk score surgical revascularization |
| Title | 外科的下肢血行再建術後の透析患者の死亡/下肢切断リスクスコア：歩行能力を考慮した検討 |
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