颈动脉内中膜厚度及尿微量白蛋白在多动脉粥样硬化患者心血管危险评估中的作用

目的探讨颈动脉内中膜厚度(carotid intima-media thickness,CIMT)及尿微量白蛋白(microalbuminuria,MA)与动脉粥样硬化患者的病情程度及心血管事件发生率之间的关系。方法选择发生在多个区域中,动脉狭窄≥50%,已施行血运重建操作的患者149例为试验组;同时选择40例动脉粥样硬化性狭窄<50%的患者作为对照,分别测定IMT和MA。结果 CIMT≥1.38 mm时,对≥3个区域动脉狭窄的敏感性和特异性分别为90.0%和82.6%。MA≥6.85 mg/dl时,对≥2个区域动脉狭窄的敏感性和特异性分别为54.9%和83.3%。试验组发生心血管事件104例。CIMT第1、2、3、4四分位数Kaplan-Meier两年无心血管事件存活率分别为93.9%、95.7%、73.9%和59.6%;MA第1、2、3、4四分位数Kaplan-Meier两年无心血管事件存活率分别为95.7%、89.6%、72.3%和66.0%。独立的心血管不良事件预测因子在多变量Cox比例风险模型中为:CIMT≥1.38 mm,RR=1.83;CI=1.049~3.196(P<0.001),MA≥6.85 mg/dl,RR=0.99;CI=0.576~1.703(P<0.001)。把CIMT引入模型分层显著提高了心血管事件危险的预测(_chi2=7.098,P<0.01),把MA引入模型分层对心血管事件危险预测影响不显著(_chi2=0.002,P<0.01)。结论经过血运重建操作的患者,测量颈动脉内中膜厚度对未来心血管危险分层有重要且独立的贡献,CIMT≥1.38 mm与1.8倍有害心血管事件有关,而尿MA≥6.85 mg/dl与近1倍有害心血管事件有关。

Roles of carotid intima-media thickness and microalbuminuria in evaluating cardiovascular risk for polyvascular atherosclerosis patients

Objective To identify the relationship of carotid intima-media thickness(CIMT),microalbuminuria(MA) level,and atherosclerosis extent with the rate of cardiovascular events in patients with polyvascular atherosclerosis.Methods A total of 149 patients with polyvascular atherosclerosis with angiographic arterial stenosis ≥50% in 1,2,3 or 4 territories(coronary,supraaortic,renal and/or lower limb arteries) who admitted in our hospital from June 2007 to June 2009 and underwent revascularization procedure in ≥1 arterial territory were enrolled in this study.These patients were divided into 4 groups according to their atherosclerosis extent,group 1 with stenosis in 1 territory(n=40),group 2 in 2 territories(n=40),group 3 in 3 territories(n=37),and group 4 in 4 territories(n=32).Baseline mean-CIMT and MA was assessed in the 149 patients and 40 control subjects who were suspected with arterial stenosis but diagnosed without after angiography at the time of hospitalization.Incidence of cardiovascular events were observed during the follow-up of 14.6±4.9 months.Results For CIMT ≥1.38 mm(≥3rd quartile),the sensitivity and specificity of ≥3-territory involvement were 90.0% and 82.6%.For MA≥6.85 mg/dl(≥3rd quartile),the sensitivity and specificity of ≥2-territory involvement were 54.9% and 83.3%.Cardiovascular events occurred in 104 subjects of 149 patients.The Kaplan Meier 2-year cardiovascular event-free survival was 93.9% and 95.7%,95.7% and 89.6%,73.9% and 72.3%;and 59.6% and 66.0% respectively in patients with mean-CIMT and MA values in the 1st,2nd,3rd and 4th quartile.The multivariable Cox proportional hazard model identified that mean-CIMT ≥1.38 mm(RR=1.83,95% CI=1.049 to 3.196;P<0.001) and MA ≥6.84 mg/dl(RR=0.99,95% CI=0.576 to 1.703;P<0.001) were independant adverse event predictors.Inclusion of CIMT into the stratification model significantly improved the prediction of cardiovascular event risk(_chi2=7.098,P<0.01) whereas the impact of MA was not significant(_chi2=0.002,P<0.01).Conclusion In patients undergoing revascularization procedure(s),CIMT exerts an important and independent contribution to further cardiovascular risk stratification.The mean-CIMT value ≥1.38 mm is associated with 1.8-fold increased risk of adverse cardiovascular events,and the MA value ≥6.85 mg/dl is associated with nearly 1-fold increased risk of adverse cardiovascular events.