Common carotid artery intima-media thickness determinants in a population study.

OBJECTIVE: Common carotid artery (CCA) intima-media thickness (IMT) is considered an atherosclerosis risk marker. Thickening of the intima-media complex is accelerated by vascular risk factors, in particular, by age and elevated blood pressure. Nonetheless, it also reflects intimal hyperplasia and intimal fibrocellular hypertrophy provoked by nonatherosclerotic mechanisms such as tensile wall stress. The aims of our study were to investigate the relationship between CCA IMT and the presence of vascular risk factors and to correlate CCA IMT with the degree of distal internal carotid artery (ICA) stenosis and the proximal CCA resistive index (RI), representative of wall stress. METHODS: We assessed CCA IMT, the CCA RI, and the presence of carotid plaques in 1655 consecutive patients. Demographic features and vascular risk factors were collected. RESULTS: A positive linear relationship between mean IMT and age was observed (R(2) = 0.27; P < .001). In the multiple stepwise regression model, the presence of ICA plaques and vascular risk factors were all independently associated with higher IMT. When considering IMT values for left and right sides separately, there was an independent relationship between CCA IMT and the lateralized percentage of ICA stenosis (right IMT-right ICA percentage, R(2) = 0.10; P < .0001; left IMT-left ICA percentage, R(2) = 0.16; P < .0001) and the CCA RI, even after correcting for age and vascular risk factors. CONCLUSIONS: Risk factors for atherosclerosis and the percentage of ICA stenosis were independently associated with higher IMT values and an increase in the RI. The synergic action of risk factors may cause further deterioration of mechanical forces independent of carotid atherosclerosis.     

北京社区人群中颈动脉内一中膜厚度特征研究

目的分析颈动脉内一中膜厚度（carotidintima-mediathickness,IMT）在健康人群不同性别、年龄组内的分布特征,探讨适合中国人群的IMT值的分布特征和参考范围。方法北京社区健康居民1256例,采用彩色多普勒超声检测颈动脉不同部位IMT值,并进行统计分析。结果IMT值随年龄增加而增加,男性组IMT值高于女性组（P〈O．05）;同年龄组、同百分位水平男性IMT值高于女性（P〈0．05）;偏相关分析显示在调整年龄、性别和体质量等危险因素后,颈总动脉IMT值与年龄、性别及体质量指数明显相关（r=一0．10,0．23,0．07,P〈0．05）;分叉处IMT值与低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平、年龄及性别明显相关（r=0．15,一0．10,0．38,0．14,P％0．05）,颈内动脉IMT值与年龄、性别、体质量、空腹血糖及低密度脂蛋白胆固醇水平明显相关（r=0．31,0．84,0．17,0．13,0．10,P〈0．05）;Bland～Altman分析显示男、女双侧颈动脉分叉处IMT值一致性良好。结论IMT值在中国健康人群不同年龄、性别间分布有明显差别,确定这一分布特征对建立适合中国人群的IMT值参考范围有重要意义。     

超声射频信号血管内中膜检测评价食物摄入因素与颈动脉硬化关系的调查研究

目的应用超声射频信号血管内中膜分析技术评估颈动脉内中膜厚度,探讨不同食物摄入对颈动脉硬化的影响。方法选取2018年2~12月在我院行颈动脉超声检查的志愿者866例,根据是否存在颈动脉硬化分为硬化组354例和非硬化组512例。使用超声射频信号血管内中膜分析技术检测颈动脉内-中膜厚度(IMT),比较两组IMT;采用偏相关分析膳食食物摄入与颈动脉硬化的相关性;应用条件Logistic回归分析不同食物摄入量与颈动脉硬化风险关系。结果硬化组颈动脉IMT厚度为829μm(724,981),非硬化组为591μm(531,664),两组比较差异有统计学意义(P<0.05)。蔬菜、水果、奶制品摄入量与颈动脉硬化呈负相关(r=-0.100、-0.198、-0.248,均P<0.05),而禽畜类摄入量与颈动脉硬化呈正相关(r=0.278,P<0.05)。校正混杂因素后,蔬菜、水果类摄入量不足及禽畜类摄入过多将增加颈动脉硬化风险(OR=1.93、2.03、3.72,均P<0.05)。结论应用超声射频信号血管内中膜分析技术可以更精准评估颈动脉内中膜厚度;合理指导食物摄入,避免颈动脉硬化的风险。     

慢性肾脏病患者Fractalkine/CX3CR1与颈动脉内膜-中层厚度的相关性

目的探讨慢性肾脏病(chronic kidney disease,CKD)患者血清Fractalkine(FKN)及其受体CX3CR1与颈动脉内膜-中层厚度的相关性。方法 CKD 3～5期患者97例(CKD组)与非CKD患者50例(对照组),检测2组血清FKN浓度、CD4+T细胞CX3CR1阳性表达率,对CKD患者FKN/CX3CR1与颈动脉内膜-中层厚度的相关性进行多元线性回归分析。结果 CKD组血清FKN浓度及CD4+T细胞CX3CR1阳性率均明显高于对照组(P<0.05);校正了传统心血管混杂因素及估算肾小球滤过率后,年龄(β=0.289,P<0.01)及CD4+T细胞CX3CR1阳性率(β=0.194,P<0.01)仍与颈动脉内膜-中层厚度密切相关。结论 FKN/CX3CR1与动脉粥样硬化密切相关,有可能作为心血管预后的一个有效指标。     

Relation between the elastic properties and intima-media thickness of the common carotid artery

The purpose of the study was to describe the relation between wall elasticity and intima-media thickness in the human carotid artery prior to the development of atherosclerotic plaques. Fifty-eight apparently healthy men, aged 42-65 years (mean 55 years), without symptoms of cardiovascular disease were studied. Thickness and elastic properties of the common carotid artery wall were assessed using ultrasonography and non-invasive arterial pressure measurements. The relation between the calculated intima-media area and the pressure strain elastic modulus was positive and statistically significant on the right but not on the left side. No statistically significant relations were found between the calculated intima-media area and the stiffness or between the intima-media thickness and the elastic modulus or stiffness on either side. Thus, the relations between the common carotid artery intima-media thickness/calculated intima-media area and the common carotid artery elastic modulus/stiffness are weak. In regions without atherosclerotic plaques, the elastic properties of the human carotid artery wall do not seem to be influenced by the wall thickness in an important way.     

老年冠心病患者颈动脉内-中膜厚度和肱动脉舒张功能的相关性

目的探讨老年冠心病患者的颈动脉内中膜厚度(IMTc)和肱动脉舒张功能及其相关性。方法采用高分辨超声检测技术观察老年冠心病组30例、老年健康组27例及非老年健康组12例的IMTc、肱动脉血流介导的血管舒张功能(FMD)和硝酸甘油介导的血管舒张功能(NID)的变化。结果老年冠心病组的IMTc显著高于老年健康组及非老年健康组,差异有统计学意义(P<0.01);老年冠心病组的FMD、NID均显著低于老年健康组和非老年健康组,差异有统计学意义(P<0.01);老年健康组的FMD显著低于非老年健康组,差异有统计学意义(P<0.01)。年龄与IMTc呈正相关(r=0.38,P<0.01),与FMD和NID呈负相关(分别为r=-0.70和-0.53,均为P<0.01);IMTc与FMD和NID呈负相关(分别为r=-0.64和-0.50,均为P<0.01)。结论老年冠心病患者常伴严重的颈动脉粥样硬化与血管内皮舒张功能障碍,并随年龄的增加而加重;IMTc、FMD等无创指标与老年冠心病具有显著相关性。     

替米沙坦对高血压患者颈动脉内膜-中层厚度及血管内皮依赖性舒张功能的影响

目的:探讨替米沙坦对高血压患者粥样硬化动脉形态及功能的影响。方法:以彩色多普勒超声检测87例高血压病患者颈动脉内膜-中层厚度,并按其大小将87例患者分为三组,连续服用替米沙坦36个月后检测颈动脉颈动脉内膜-中层厚度和未受干预状态下、肱动脉反应性充血时以及含服硝酸甘油后颈动脉内径,与治疗前进行比较。结果:使用替米沙坦8周后血压能控制在140/90 mmHg以下且保持平稳。治疗36个月后,三组的颈动脉颈动脉内膜-中层厚度与治疗前比较明显下降。三组治疗后肱动脉反应性充血时颈动脉内径的变化率与治疗前比较有明显改善,含服硝酸甘油后颈动脉内径在治疗前后无显著变化。结论:血管紧张素Ⅱ受体桔抗剂替米沙坦在平稳降压的同时,能保护血管内皮细胞,改善血管内皮依赖性舒张功能,延缓甚至逆转颈动脉内膜-中层厚度的进展。     

耳折征患者颈动脉内膜中层厚度和斑块发生率的临床观察

目的 分析双侧耳折征(DELC)患者的颈动脉内膜中层厚度(IMT)、颈动脉斑块发生率的情况。方法 选取50岁以上患者110例,其中DELC组60例,对照组50例。所有患者测量体质量、身高,记录吸烟史及高血压病、2型糖尿病、脑梗死、心肌梗死病史,应用彩色多普勒超声检查颈动脉结构。对比两组年龄、男性比例、体质量指数(BMI)、吸烟率、患病率(高血压病、2型糖尿病、脑梗死、心肌梗死)、颈动脉IMT、斑块发生率。结果 与对照组相比,DELC组BMI、吸烟者无显著增加,但年龄更大[(72.6±8.4)岁比(66.1±14.7)岁,P0.05],高血压病(75.0%比56.0%,P0.05)、2型糖尿病(45.0%比26.0%,P0.05)、陈旧性脑梗死(43.3%比22.0%,P0.05)、陈旧性心肌梗死(36.7%比16.0%,P0.05)患病率更高。与对照组相比,DELC组颈动脉IMT明显增厚[(1.21±0.27)mm比(0.84±0.21)mm,P0.05)],斑块发生率明显增加(85%比62%,P0.05)。结论 对于DELC患者,应加强动脉粥样硬化及其危险因素的筛查。     

替米沙坦联合瑞舒伐他汀钙对动脉粥样硬化性血栓性脑梗死患者颈动脉内膜-中层厚度的影响

目的：探讨替米沙坦联合瑞舒伐他汀钙对动脉粥样硬化性血栓性脑梗死患者颈动脉内膜-中层厚度（IMT）的影响.方法：98例动脉粥样硬化性血栓性脑梗死患者随机分为治疗组（B组）和对照组（A组）各49例,均予替米沙坦80 mg/d降压治疗,治疗组在此基础上加用瑞舒伐他汀钙10 mg/d.治疗16周后,比较两组治疗前后血压、血脂及IMT的变化.结果：B组治疗16周后,血总胆固醇、三酰甘油、LDL-C下降较A组更显著（P〈0.05）,IMT降低较A组更显著（P〈0.01）.结论：替米沙坦联合瑞舒伐他汀钙在平稳降压、有效调脂的同时,能保护血管内皮细胞,延缓颈动脉粥样硬化病变的进展.     

2型糖尿病患者尿白蛋白排泄率与颈动脉内膜厚度关系的研究

目的 观察2型糖尿病患尿白蛋白排泄率(AER)与大血管病变的关系。方法 用高分辨率超声对122例2型糖尿病患的颈动脉内膜厚度(IMT)进行检测，同时测定尿AER，并对两关系进行统计分析。结果 2型糖尿病患颈动脉IMT与尿AER存在独立正相关。结论 尿AER增高是2型糖尿病患大血管病变的独立危险因素。     

Tissue inhibitor of matrix metalloproteinases 4 (TIMP4) in a population of young adults: Relations to cardiovascular risk markers and carotid artery intima-media thickness. The Cardiovascular Risk in Young Finns Study

Objectives. The tissue inhibitor of metalloproteinases 4 (TIMP4) is present in significant amounts in human atherosclerotic coronary artery lesions, but its relations with the early pathogenesis of atherosclerotic changes have not been clarified. We studied the associations of circulating TIMP4 with pre-clinical markers of atherosclerosis and traditional cardiovascular risk factors by using longitudinal data on carotid artery intima-media (cIMT) thickness in a population-based cohort of asymptomatic young adult Finns. Methods. Data on cIMT, plasma TIMP4, lipids, CRP, blood pressure, BMI, smoking status and daily alcohol intake were obtained from 980 24–39 year-old participants in 2001. The 6-year follow-up in cIMT measurements were performed in 2007 for 769 participants. Results. Plasma TIMP4 concentrations (mean ± SD) were 2.3 ± 1.7 ng/mL in men and 2.5 ± 1.8 ng/mL in women. Age, LDL-cholesterol, BMI and systolic blood pressure were directly associated with TIMP4 concentration. In a multivariable model, the independent determinants of TIMP4 included systolic blood pressure (p = 0.008) and daily smoking (p = 0.009), both being inversely associated with TIMP4. These two baseline variables explained 1.5% of the variation in TIMP4. TIMP4 was significantly and inversely associated with cIMT measured 6 years later (beta =? 0.0135, p = 0.01) explaining 0.7% of the variability of cIMT. Conclusion. In young apparently healthy adults, circulating TIMP4 concentration was independently and inversely associated with cIMT, a marker of vascular structure and function.     

Low HDL cholesterol concentration is associated with increased intima-media thickness independent of arterial stiffness in healthy subjects from families with low HDL cholesterol

BACKGROUND: Low high-density lipoprotein cholesterol (HDL-C) is associated with increased risk for developing coronary artery disease. Cardiovascular disease is characterized by increased intima-media thickness (IMT) and arterial stiffness, but the effect of low HDL on these measurements has not been reported. MATERIALS AND METHODS: We studied 18 apparently healthy subjects from families with low HDL-C and 18 control subjects, which were pair-matched to maximize statistical power. Intima-media thickness was assessed using ultrasound examination of the carotid arteries. Arterial stiffness was measured using applanation tonometry on the radial artery and pulse-wave analysis to obtain central aortic pulse-pressure waveform, from which the augmentation index, a measure of global large artery stiffness, was calculated. RESULTS: Low HDL subjects (age 41 +/- 3 years, BMI 26.6 +/- 1.0 kg m(-2) had significantly lower HDL-C than the control subjects (age 41 +/- 3 years, BMI 26.5 +/- 1.0 kg m-2; 1.00 +/- 0.05 vs. 1.49 +/- 0.09 mmol L-1, low HDL vs. control subjects, P < 0.0001). Subjects with low HDL-C had significantly thicker mean IMTs than the control subjects (0.77 +/- 0.03 vs. 0.70 +/- 0.02 mm, low HDL vs. control subjects, P < 0.01). The maximal (0.99 +/- 0.04 vs. 0.89 +/- 0.03 mm, P < 0.01), far wall (0.76 +/- 0.04 vs. 0.69 +/- 0.02 mm, P < 0.05) and carotid bulb (1.11 +/- 0.06 vs. 0.97 +/- 0.04 mm) IMTs were also significantly increased, whereas the mean common carotid and the internal artery IMT were not. The age-related increase in mean IMT was more pronounced in the low HDL subjects than the control subjects (P < 0.01 for difference between elevations of age vs. IMT slopes). There were no differences in central pressure augmentation, the augmentation index, peripheral or central blood pressures between the groups. CONCLUSIONS: A low HDL-C concentration is associated with thickening of carotid IMT independent of other risk factors in healthy affected members of low HDL families.     

2型糖尿病患者颈动脉内膜中层厚度与血清脂联素的相关性

目的 探讨2型糖尿病患者颈动脉内膜中层厚度（IMT）与血清脂联素（adiponectin）相关性。方法对65例2型糖尿病患者和60例正常对照者,分别测定血清脂联素（adiponectin）及生化指标,采用超声测定IMT,比较两组间血清脂联素（adiponectin）及IMT水平。对2型糖尿病患者采用多元回归分析,统计颈动脉IMT和血清脂联素（adiponectin）之间的关系。结果血清脂联素（adiponectin）与2型糖尿病患者颈动脉IMT增厚有关。结论2型糖尿病患者颈动脉IMT与血清脂联素（adiponectin）呈正相关,提示2型糖尿病患者血清脂联素（adiponectin）可协助诊断冠心病。     

Ultrasound protocols to measure carotid intima-media thickness in trials; comparison of reproducibility,rate of progression,and effect of intervention in subjects with familial hypercholesterolemia and subjects with mixed dyslipidemia

Abstract

Background. Current ultrasound protocols to measure carotid intima-media thickness (CIMT) in trials rather differ. The ideal protocol combines high reproducibility with a high precision in the measurement of the rate of change in CIMT over time and with a precise estimate of a treatment effect. To study these aspects, a post-hoc analysis was performed using data from two randomized double-blind, placebo-controlled trials: one among 872 subjects with familial hypercholesterolemia (FH) and the other among 752 subjects with mixed dyslipidemia (MD), respectively. Participants were randomized to torcetrapib or placebo on top of optimal atorvastatin therapy.

Methods. CIMT information was collected from the left and right carotid artery from two walls (the near and far wall) of three segments (common carotid, bifurcation, and internal carotid artery) at four different angles (right: 90, 120, 150, and 180 degrees on Meijer's carotid arc; left: 270, 240, 210, and 180 degrees, respectively). Based on combinations of these measurements, 60 different protocols were constructed to estimate a CIMT measure per participant (20 protocols for mean common CIMT, 40 protocols for mean maximum CIMT). For each protocol we assessed reproducibility (intra-class correlation coefficient (ICC), mean difference of duplicate base-line scans); 2-year progression rate in the atorvastatin group with its standard error (SE); and treatment effect (difference in rate of change in CIMT between torcetrapib and placebo) with its SE.

Results. Reproducibility: ICC ranged from 0.77 to 0.91 among FH patients and from 0.68 to 0.86 among MD patients. CIMT progression rates ranged from ?0.0030 to 0.0020 mm/year in the FH trial and from 0.00084 to 0.01057 mm/year in the MD trial, with SE ranging from 0.00054 to 0.00162 and from 0.00083 to 0.00229, respectively. The difference in CIMT progression rate between treatment arms ranged from ?0.00133 to 0.00400 mm/year in the FH trial and from ?0.00231 to 0.00486 mm/year in the MD trial. The protocol with the highest reproducibility, highest CIMT progression/precision ratio, and the highest treatment effect/precision ratio were those measuring mean common CIMT with measurements of the near and far wall at multiple angles. When the interest is in the mean maximum CIMT, protocols using multiple segments and angles performed the best.

Conclusion. Our findings support the position that the number and specific combination of segments, angles, and walls interrogated are associated with differences in reproducibility, magnitude, and precision of progression of CIMT over time, and treatment effect. The best protocols were mean common CIMT protocols in which both the near and far walls are measured at multiple angles.

Trial registration: ClinicalTrials.gov identifier: NCT00136981.

Trial registration: ClinicalTrials.gov identifier: NCT00134264.     

2型糖尿病患者高敏C反应蛋白与颈动脉内膜中层厚度的相关研究

目的研究2型糖尿病(T2DM)患者高敏C反应蛋白(hsCRP)与颈动脉内膜中层厚度(IMT)的关系。方法选取62例T2DM患者和30例正常对照者,用免疫透射比浊法测定hsCRP及用高分辨彩色多普勒测定颈动脉IMT,根据所测的hsCRP水平将T2DM患者分为低hsCRP组(0.05~3 mg/L)30例,高hsCRP组(>3~10 mg/L)32例;T2DM患者给予降糖、调脂等综合性治疗1年,再测定治疗后hsCRP和颈动脉IMT,分析hsCRP与颈动脉IMT变化的关系。结果T2DM患者综合治疗1年后,高hsCRP组颈动脉IMT的增厚明显高于低hsCRP组[(1.05±0.15)mm vs(0.84±0.12)mm(P<0.05)];相关分析中,T2DM患者高hsCRP组在治疗前、后颈动脉IMT与hsCRP呈正相关(r=0.882,r=0.905,均P<0.05)。结论在T2DM中,hsCRP水平的增高与颈动脉IMT的增厚有关,提示血清hsCRP增高可能是T2DM患者合并早期动脉粥样硬化的危险因素之一。     

Stiffness of the common carotid artery in healthy 50-year-old subjects

We examined whether, in a group of healthy 50 year-old subjects, there was a relation between the stiffness of the common carotid artery and risk factors for atherosclerosis and, further, if there was a sex difference in these healthy individuals. A group of 248 healthy subjects (123 men and 125 women), all 50 years of age, were examined. The elastic properties of the common carotid artery, measured in terms of stiffness index, were investigated with an ultrasound technique. Men had significantly higher stiffness index than women (5·46 ± 1·32 vs. 5·04 ± 1·05, P<0·01). The arterial diameter was significantly larger in men. When comparing stiffness index in a subgroup of 38 men and women with similar arterial diameters, no significant difference in stiffness index was found. Multivariate analysis showed that smoking habits, measured as pack–years, insulin levels and the low-density lipoprotein (LDL)-/high-density lipoprotein (HDL)-cholesterol ratio was independently significantly associated with the stiffness index. Sex did not emerge as a significant variable. In conclusion, there is a relation between the stiffness of the carotid arteries and risk factors for atherosclerosis such as smoking, insulin levels and LDL-/HDL-cholesterol ratio in healthy 50-year-old subjects. The stiffness is higher in men than in women, probably dependent on differences in arterial size and possibly also on risk factors.     

人文关怀护理在多因素干预对新发2型糖尿病患者颈总动脉内中膜厚度增厚影响研究中的意义

目的：探讨人文关怀护理在多因素干预对新发2型糖尿病患者颈总动脉内中膜厚度增厚影响研究的应用。方法：90例新发2型糖尿病患者随机分为干预组及对照组各45例。对照组实施常规护理,干预组在此基础上给予人文关怀护理,实施多元化的健康教育和心理干预。结果：干预后干预组患者颈总动脉内中膜厚度、糖化血红蛋白、血清总胆固醇、甘油三酯水平下降幅度均大于对照组（P〈O．05）。结论：人文关怀护理能延缓多因素综合干预条件下新诊2型糖尿病患者颈总动脉内中膜厚度的进展。     

血清脂联素及C反应蛋白与2型糖尿病患者颈动脉内膜中层厚度的关系

目的探讨血清脂联素及C反应蛋白与2型糖尿病患者颈动脉平均内膜中层厚度（IMT）的相关性。方法测定89例2型糖尿病患者颈总动脉平均IMT、血清脂联素、（hs）CRP及其他生化指标,按颈总动脉平均IMT将患者分为内膜正常组、内膜增厚组、斑块形成组、管腔狭窄组,比较各组间血清脂联素、（hs）CRP水平。对颈总动脉内膜异常患者,采用多元回归分析,统计颈总动脉IMT和血清脂联素、（hs）CRP之间的关系。结果内膜正常组、内膜增厚组、斑块形成组、管腔狭窄组各组间血清脂联素水平逐渐降低,（hs）CRP水平逐渐增高,4组间比较差异有统计学意义（P〈0．01,P〈0．05）。动脉硬化组中颈总动脉IMT与血清脂联素呈负相关（P〈0．01）、与（hs）CRP呈正相关（P〈0．05）。结论血清脂联素、（hs）CRP可能与2型糖尿病患者颈总动脉IMT的增厚有关,提示2型糖尿病患者血清脂联素与（hs）CRP可协助诊断冠心病。     

Intima-media thickness of the common carotid artery in highway toll collectors

PURPOSE: To assess the effects of exposure to exhaust particles on intima-media thickness of the common carotid artery in highway toll collectors. METHODS: Sixty-one highway toll collectors (HTCs) between 24 and 56 years of age (mean, 36.2 +/- 7.3) and 48 controls between 24 and 64 years of age (mean, 42.6 +/- 10.6) were evaluated with gray-scale sonography to measure intima-media thickness (IMT) of the common carotid artery (CCA). Subgroups were categorized according to duration of exhaust exposure and further divided according to tobacco use. RESULTS: CCA IMT was higher (0.8 +/- 0.2 mm) in HTCs than in the control group (0.6 +/- 0.1 mm; p < 0.001) and remained higher when subgroups with similar smoking habits were compared. In HTCs, IMT was greater when the number of years working in tollbooths was greater (p = 0.023). IMT was lower in HTCs with an exposure duration of < 10 years compared with a duration of 10-20 years (p = 0.017) or > 20 years (p value not significant). CONCLUSION: Air pollution has a widely acknowledged negative effect on humans. This study confirms that exposure to exhaust particles might cause wall thickening of carotid arteries.