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Circ Cardiovasc Imaging:心血管疾病预测三足鼎立:冠状动脉钙化、颈动脉斑块、颈动脉内膜中层厚度

2015-01-26 MedSci MedSci原创

内膜中层厚度(IMT),颈动脉斑块,冠状动脉钙化的评价在动脉粥样硬化的筛查中起到了重要的作用。动脉粥样硬化多种族研究提到,对于冠心病和心血管疾病的预测选用冠状动脉钙化而不是IMT,对于卒中的预测应选用IMT而不是冠状动脉钙化,然而这些分析都有其局限性:部分心血管事件随访过短。心血管健康研究中对冠状动脉钙化和IMT做了对比,但是参与者年龄更大,而且随访也很短。虽然IMT,颈动脉斑块,冠状动脉钙化

内膜中层厚度(IMT),颈动脉斑块,冠状动脉钙化的评价在动脉粥样硬化的筛查中起到了重要的作用。动脉粥样硬化多种族研究提到,对于冠心病和心血管疾病的预测选用冠状动脉钙化而不是IMT,对于卒中的预测应选用IMT而不是冠状动脉钙化,然而这些分析都有其局限性:部分心血管事件随访过短。心血管健康研究中对冠状动脉钙化和IMT做了对比,但是参与者年龄更大,而且随访也很短。虽然IMT,颈动脉斑块,冠状动脉钙化在很多队列研究和Meta分析中都有描述,但是并未直接将单独队列研究进行长期随访,也未对大样本心血管事件做对比研究。

背景:冠状动脉钙化,颈动脉斑块的出现,以及IMT的增加都会升高心血管疾病风险;然而,并没有大量研究对它们进行对比研究。本研究比较了冠状动脉钙化的产生,颈动脉斑块的形成,高IMT对心血管疾病事件的预测性。

方法和结果:从冠状动脉粥样硬化多种族研究(MESA)中遴选患者。通过Cox比例风险模型,C统计量, 净重新分类指数对颈动脉斑块,IMT,冠状动脉钙化的预测值进行比较。6779位患者,平均年龄(标准差)62.2(10.2)岁;其中49.9%患有冠状动脉钙化,46.7%患有颈动脉斑块。左、右IMT的平均值分别为0.754(0.210)mm和0.751(0.187)mm。9.5年后,538位患者有心血管疾病,388位患者有冠心病,196位患者有卒中/短暂性缺血损伤。相对于颈动脉超声检测,冠状动脉钙化在心血管疾病和冠心病中更具有预测价值。单独中膜厚度平均值≥75%并不具有预测性。和传统的危险因子相比较,C统计量对于心血管疾病(c=0.756)和冠心病(c=0.752)而言,随着颈动脉斑块的形成,冠状动脉钙化也同样会产生(心血管疾病,0.776;冠心病,0.784;P<0.001)。就危险因素而言(c=0.782),颈动脉斑块的形成(c=0.787;P=0.045)而不是冠状动脉钙化形成(c=0.785;P=0.483)提高了卒中/短暂性缺血损伤的预测。

结论:10年随访研究显示:中年人中,未患有心血管疾病、冠状动脉钙化的患者比患有颈动脉斑块、高IMT的患者,在心血管疾病、心脏疾病中更具有预测性。冠状动脉钙化和颈动脉超声参数对卒中/短暂性缺血损伤的预测性相似。

原文出处:

Gepner AD, Young R, Delaney JA, Tattersall MC, Blaha MJ, Post WS, Gottesman RF, Kronmal R, Budoff MJ, Burke GL, Folsom AR, Liu K, Kaufman J, Stein JH. Comparison of coronary artery calcium presence, carotid plaque presence, and carotid intima-media thickness for cardiovascular disease prediction in the multi-ethnic study of atherosclerosis. Circulation Cardiovascular imaging. 2015;Jan8(1).

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  4. 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createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzTetibytbqFDmFITWHyBWbxU7S9MYibgPSqvu0sYteH0N6zXqbU0Kf3Mbdb7yWM1Kud3zPgYBibE2SZ/0, createdBy=da7696924, createdName=qingfengqishi5, createdTime=Mon Aug 10 23:23:00 CST 2015, time=2015-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1973490, encodeId=285419e349044, content=<a href='/topic/show?id=3e72309122a' target=_blank style='color:#2F92EE;'>#冠状动脉钙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30912, encryptionId=3e72309122a, topicName=冠状动脉钙)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/B389FA68ECBF51BE2FE14093CF61F6AE/100, createdBy=eb8e2500096, createdName=夏天与十三菇凉, createdTime=Sat Oct 17 06:29:00 CST 2015, time=2015-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663248, encodeId=dc6916632486d, content=<a 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16241, encodeId=293a16241d2, content=已阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=da6b7222, createdName=chinayinhan, createdTime=Tue Feb 17 01:00:00 CST 2015, time=2015-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1269172, encodeId=cc2212691e29c, content=<a href='/topic/show?id=686830913f7' target=_blank style='color:#2F92EE;'>#冠状动脉钙化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30913, encryptionId=686830913f7, topicName=冠状动脉钙化)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, createdName=shizhenshan, createdTime=Wed Jan 28 00:29:00 CST 2015, time=2015-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1280758, encodeId=23ed1280e581c, content=<a href='/topic/show?id=c6ba1005490e' target=_blank style='color:#2F92EE;'>#颈动脉斑块#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100549, encryptionId=c6ba1005490e, topicName=颈动脉斑块)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7387164, createdName=zhangj7108, createdTime=Wed Jan 28 00:29:00 CST 2015, time=2015-01-28, status=1, ipAttribution=)]
    2015-08-10 qingfengqishi5

    不错哦,收藏了!

    0

  5. 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  6. 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  7. [GetPortalCommentsPageByObjectIdResponse(id=1938455, encodeId=64b5193845545, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Sun Aug 23 08:29:00 CST 2015, time=2015-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1708309, encodeId=e3ba1e08309f3, content=<a href='/topic/show?id=4c2d3051535' target=_blank style='color:#2F92EE;'>#内膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30515, encryptionId=4c2d3051535, topicName=内膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=730431558473, createdName=12498974m61暂无昵称, createdTime=Sat Jul 04 05:29:00 CST 2015, time=2015-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843382, encodeId=2537184338223, content=<a href='/topic/show?id=dab8100523bb' target=_blank style='color:#2F92EE;'>#颈动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100523, encryptionId=dab8100523bb, topicName=颈动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Sat Oct 03 03:29:00 CST 2015, time=2015-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35409, encodeId=fffe3540929, content=不错哦,收藏了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzTetibytbqFDmFITWHyBWbxU7S9MYibgPSqvu0sYteH0N6zXqbU0Kf3Mbdb7yWM1Kud3zPgYBibE2SZ/0, createdBy=da7696924, createdName=qingfengqishi5, createdTime=Mon Aug 10 23:23:00 CST 2015, time=2015-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1973490, encodeId=285419e349044, content=<a href='/topic/show?id=3e72309122a' target=_blank style='color:#2F92EE;'>#冠状动脉钙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30912, encryptionId=3e72309122a, topicName=冠状动脉钙)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/B389FA68ECBF51BE2FE14093CF61F6AE/100, createdBy=eb8e2500096, createdName=夏天与十三菇凉, createdTime=Sat Oct 17 06:29:00 CST 2015, time=2015-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663248, encodeId=dc6916632486d, content=<a href='/topic/show?id=4bae3334873' target=_blank style='color:#2F92EE;'>#动脉钙化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33348, encryptionId=4bae3334873, topicName=动脉钙化)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3d1d25597695, createdName=1249897bm45(暂无昵称), createdTime=Wed Jul 29 14:29:00 CST 2015, time=2015-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33212, encodeId=5b6b33212b2, content=不错哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzTetibytbqFDmFITWHyBWbxU7S9MYibgPSqvu0sYteH0N6zXqbU0Kf3Mbdb7yWM1Kud3zPgYBibE2SZ/0, createdBy=da7696924, createdName=qingfengqishi5, createdTime=Tue Jul 21 11:45:00 CST 2015, time=2015-07-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16241, encodeId=293a16241d2, content=已阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=da6b7222, createdName=chinayinhan, createdTime=Tue Feb 17 01:00:00 CST 2015, time=2015-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1269172, encodeId=cc2212691e29c, content=<a href='/topic/show?id=686830913f7' target=_blank style='color:#2F92EE;'>#冠状动脉钙化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30913, encryptionId=686830913f7, topicName=冠状动脉钙化)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, createdName=shizhenshan, createdTime=Wed Jan 28 00:29:00 CST 2015, time=2015-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1280758, encodeId=23ed1280e581c, content=<a href='/topic/show?id=c6ba1005490e' target=_blank style='color:#2F92EE;'>#颈动脉斑块#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100549, encryptionId=c6ba1005490e, topicName=颈动脉斑块)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7387164, createdName=zhangj7108, createdTime=Wed Jan 28 00:29:00 CST 2015, time=2015-01-28, status=1, ipAttribution=)]
    2015-07-21 qingfengqishi5

    不错哦

    0

  8. 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createdName=12498974m61暂无昵称, createdTime=Sat Jul 04 05:29:00 CST 2015, time=2015-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843382, encodeId=2537184338223, content=<a href='/topic/show?id=dab8100523bb' target=_blank style='color:#2F92EE;'>#颈动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100523, encryptionId=dab8100523bb, topicName=颈动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Sat Oct 03 03:29:00 CST 2015, time=2015-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35409, encodeId=fffe3540929, content=不错哦,收藏了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzTetibytbqFDmFITWHyBWbxU7S9MYibgPSqvu0sYteH0N6zXqbU0Kf3Mbdb7yWM1Kud3zPgYBibE2SZ/0, createdBy=da7696924, createdName=qingfengqishi5, createdTime=Mon Aug 10 23:23:00 CST 2015, time=2015-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1973490, encodeId=285419e349044, content=<a href='/topic/show?id=3e72309122a' target=_blank style='color:#2F92EE;'>#冠状动脉钙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30912, encryptionId=3e72309122a, topicName=冠状动脉钙)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/B389FA68ECBF51BE2FE14093CF61F6AE/100, createdBy=eb8e2500096, createdName=夏天与十三菇凉, createdTime=Sat Oct 17 06:29:00 CST 2015, time=2015-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663248, encodeId=dc6916632486d, content=<a href='/topic/show?id=4bae3334873' target=_blank style='color:#2F92EE;'>#动脉钙化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33348, encryptionId=4bae3334873, topicName=动脉钙化)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3d1d25597695, createdName=1249897bm45(暂无昵称), createdTime=Wed Jul 29 14:29:00 CST 2015, time=2015-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33212, encodeId=5b6b33212b2, content=不错哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzTetibytbqFDmFITWHyBWbxU7S9MYibgPSqvu0sYteH0N6zXqbU0Kf3Mbdb7yWM1Kud3zPgYBibE2SZ/0, createdBy=da7696924, createdName=qingfengqishi5, createdTime=Tue Jul 21 11:45:00 CST 2015, time=2015-07-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16241, encodeId=293a16241d2, content=已阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=da6b7222, createdName=chinayinhan, createdTime=Tue Feb 17 01:00:00 CST 2015, time=2015-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1269172, encodeId=cc2212691e29c, content=<a href='/topic/show?id=686830913f7' target=_blank style='color:#2F92EE;'>#冠状动脉钙化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30913, encryptionId=686830913f7, topicName=冠状动脉钙化)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, createdName=shizhenshan, createdTime=Wed Jan 28 00:29:00 CST 2015, time=2015-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1280758, encodeId=23ed1280e581c, content=<a href='/topic/show?id=c6ba1005490e' target=_blank style='color:#2F92EE;'>#颈动脉斑块#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100549, encryptionId=c6ba1005490e, topicName=颈动脉斑块)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7387164, createdName=zhangj7108, createdTime=Wed Jan 28 00:29:00 CST 2015, time=2015-01-28, status=1, ipAttribution=)]
    2015-02-17 chinayinhan

    已阅

    0

  9. 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href='/topic/show?id=4bae3334873' target=_blank style='color:#2F92EE;'>#动脉钙化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33348, encryptionId=4bae3334873, topicName=动脉钙化)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3d1d25597695, createdName=1249897bm45(暂无昵称), createdTime=Wed Jul 29 14:29:00 CST 2015, time=2015-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33212, encodeId=5b6b33212b2, content=不错哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzTetibytbqFDmFITWHyBWbxU7S9MYibgPSqvu0sYteH0N6zXqbU0Kf3Mbdb7yWM1Kud3zPgYBibE2SZ/0, createdBy=da7696924, createdName=qingfengqishi5, createdTime=Tue Jul 21 11:45:00 CST 2015, time=2015-07-21, 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GetPortalCommentsPageByObjectIdResponse(id=1280758, encodeId=23ed1280e581c, content=<a href='/topic/show?id=c6ba1005490e' target=_blank style='color:#2F92EE;'>#颈动脉斑块#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100549, encryptionId=c6ba1005490e, topicName=颈动脉斑块)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7387164, createdName=zhangj7108, createdTime=Wed Jan 28 00:29:00 CST 2015, time=2015-01-28, status=1, ipAttribution=)]
  10. 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