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估计有2.7亿国人有颈动脉粥样硬化!Lancet子刊研究估计,全球20亿

2020-05-08 卢芳 文韬 中国循环杂志

近日,北京大学学者发表在Lancet子刊上的一项全球21个国家和地区59项研究的Meta分析估算,2020年全球有近20亿人颈动脉粥样硬化。

近日,北京大学学者发表在Lancet子刊上的一项全球21个国家和地区59项研究的Meta分析估算,2020年全球有近20亿人颈动脉粥样硬化。

 

该课题组之前发表的中国数据中,2010年30~79岁国人中, 估计2亿人(27%)有颈动脉粥样硬化,1.5亿人(20%)有颈动脉斑块;超70%的颈动脉粥样硬化在农村。

 

预计到2020年,有2.7亿国人有颈动脉粥样硬化,2亿人有颈动脉斑块。

 

颈动脉粥样硬化定义为颈动脉内中膜厚度≥1.0 mm。

 

中国慢病前瞻性研究一项分析显示,中国有三分之一成人存在颈动脉粥样斑块。

 

哈尔滨医科大学附属第二医院于波等指出,斑块负荷在预测冠脉事件中更有优势。

 

“中美心血管病和心肺疾病流行病学合作研究”也发现,颈动脉粥样硬化斑块的变化,可预测未来冠心病风险。

 

只要有斑块,不管是之后斑块缩小、斑块稳定还是进展,发生冠心病事件的风险均升高。

 

斑块进展的快慢与血压、血糖、血脂、吸烟等均显著相关。

 

该研究还发现,一旦有了粥样硬化斑块,发生冠心病或脑卒中就升高,对有斑块的患者要纠正高血压、高脂血症和吸烟等危险因素。但即使斑块较前减少,其危险也较高,或许应服用他汀类药物进行预防。

 

Lancet子刊这项研究估计,2020年全球30~79岁人群中:

 

27.6%颈动脉中膜厚度增加,估计10.7亿人受累,较之2000年增加了57.46%;

 

21.1%为颈动脉斑块,有8.2亿受累,较2000年增加了58.97%;

 

1.5%有颈动脉狭窄,有5779万人受累,比2000年增加了59.13%。

 

其中,50~59岁人群百分比变化最大。

 

此外,研究还显示,颈动脉中膜厚度增加、颈动脉斑块和颈动脉狭窄随增龄而增加,且男性更为多见。

 

吸烟、糖尿病、高血压都是颈动脉中膜厚度增加、颈动脉斑块的最常见危险因素。

 

2015年,西太平洋地区颈动脉中膜厚度增加、颈动脉斑块的患者全球最多,分别有33%和33%的人受累,而非洲地区这类患者最少,受累人群分别为6%和6%。

 

图1 全球不同地区不同年龄人群颈动脉中膜厚度增加、颈动脉斑块的患者分布

 

研究者指出,全球颈动脉粥样硬化疾病负担较重,应开展高质量的流行病学调查研究更好去研究和解决这一公共卫生问题。

 

北京大学人民医院陈红等指出,对于颈动脉粥样硬化性疾病,不论患者有无症状,均需尽力纠正可能导致血管阻塞的危险因素,包括戒烟、适当体力活动和必要的药物治疗。此外,对于合适的患者可考虑血运重建,优选颈动脉内膜剥脱术。

 

但值得注意的是, 在一项对全国8581例内科医师中进行的调查发现,只有三成医师认为脑卒中需要控制高血压、糖尿病等危险因素。

 

对于症状性颈动脉粥样硬化性疾病的治疗,仅10.4%的医生选择颈动脉内膜剥脱术、抗血小板药物和控制危险因素的联合治疗。

 

此外,颈动脉疾病的筛查应掌握严格指征,不建议常规体检筛查。目前欧洲指南建议符合以下条件之一应筛查颈动脉疾病:

 

年龄>75岁;

 

冠状动脉左主干病变;

 

严重外周动脉疾病;

 

短暂性脑缺血发作或脑卒中;

 

颈动脉杂音。

 

美国指南则增加吸烟,年龄提前至65岁,外周动脉疾病无严重程度限制,以及脑卒中改为心血管疾病。

 

发表在Lancet子刊上的这项Meta分析建模研究,纳入了59项研究30~79岁人群,涵盖了全球21个国家和地区。并应用联合国2000年、2015年和2020年人口数据进行了人群流行病学估算,并基于风险因素为基础的模型估计了2015年伴有颈动脉中膜厚度变厚和颈动脉斑块的区域人群。

 

其中,颈部双侧超声检查示颈动脉中膜厚度增加≥1.0 mm,颈动脉斑块定义为局灶性颈动脉中膜厚度≥1.5 mm,且侵入血管至少0.5 mm或50%,以及颈动脉狭窄≥50%,均视为颈动脉粥样硬化。

 

来源:

[1]Song P, Fang Z, Wang H, et al. Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: a systematic review, meta-analysis, and modelling study. Lancet Glob Health, 2020, 8(5): e721-e729.

[2]Song P, Xia W, Zhu Y, et al. Prevalence of carotid atherosclerosis and carotid plaque in Chinese adults: A systematic review and meta-regression analysis. Atherosclerosis, 2018, 276:67-73

[3]高睿, 于波. 通过颈动脉斑块特征评价冠状动脉斑块特征. 中国循环杂志, 2019,34: 1240-1243.

[4]王梦, 谢高强, 王浩, 等. 颈动脉最大斑块面积的进展速率与新发缺血性心血管事件的关系. 中国循环杂志, 2014, 29:532-536.

[5]伍满燕, 梁文卿, 陈江天, 等. 颈动脉粥样硬化性疾病的诊治进展. 中华老年心脑血管病杂志, 2019, 21: 1223-1226.

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    2020-09-12 howi
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    2020-05-08 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

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“中国卒中防治工程“项目组分析了84880名中国居民的颈动脉超声数据,发现中国≥40岁居民中有36.2%颈动脉粥样硬化。

影像学在颈动脉粥样硬化斑块检查中的应用

脑血管病具有发病率高、致残率高、病死率高及复发率高的特点,严重影响国民健康和国家的健康战略。颈动脉粥样硬化易损斑块的破裂、栓塞、局部血栓形成以及造成的管腔狭窄、引起的血流动力学改变是引起缺血性脑卒中和短暂性脑缺血的重要危险因素。

ATVB:基于人种的脂蛋白差异(a)相关的颈动脉粥样硬化风险

由此可见,人种是Lp(a)相关的颈动脉斑块风险的可改变变量,Lp(a)水平对白人斑块负荷的影响可能大于黑人个体。西班牙裔的临界结果表明Lp(a)升高可能会增加颈动脉斑块的风险,但需要进行后续研究。

JAHA:早期情绪症状预测青少年颈动脉粥样硬化

由此可见,在这个大型出生队列中,青春期ESs与年轻成人颈动脉内膜中层厚度之间存在纵向相关。这种关联是直接的,不是由传统的心血管危险因素所介导。按性别进行的相互作用可能对设计未来的干预措施具有重要指导意义。

J Hepatol:DAA药物治疗清除HCV病毒后可改善严重肝纤维化患者的颈动脉粥样硬化

DAA根除丙型肝炎病毒可改善严重纤维化患者的颈动脉粥样硬化,无论有无额外的代谢危险因素。从长期来看,动脉粥样硬化负担的改善对主要心血管疾病减少的影响是值得研究的。

Stroke:睡眠呼吸暂停与亚临床颈动脉粥样硬化之间的关系

在这个大型的多民族人群样本中,睡眠障碍与男性和女性亚临床颈动脉粥样硬化相关,尤其是那些<68岁的个体。SA与颈动脉粥样硬化之间关联的潜在机制可能因颈动脉斑块和颈内膜中膜厚度而异。

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