Spence J David, Eliasziw Michael, DiCicco Maria, Hackam Daniel G, Galil Ramzy, Lohmann Tara
Robarts Research Institute and University of Western Ontario, London.
Stroke. 2002 Dec;33(12):2916-22. doi: 10.1161/01.str.0000042207.16156.b9.
Carotid plaque area measured by ultrasound (cross-sectional area of longitudinal views of all plaques seen) was studied as a way of identifying patients at increased risk of stroke, myocardial infarction, and vascular death.
Patients from an atherosclerosis prevention clinic were followed up annually for up to 5 years (mean, 2.5+/-1.3 years) with baseline and follow-up measurements recorded. Plaque area progression (or regression) was defined as an increase (or decrease) of >/=0.05 cm(2) from baseline.
Carotid plaque areas from 1686 patients were categorized into 4 quartile ranges: 0.00 to 0.11 cm(2) (n=422), 0.12 to 0.45 cm(2) (n=424), 0.46 to 1.18 cm(2) (n=421), and 1.19 to 6.73 cm(2) (n=419). The combined 5-year risk of stroke, myocardial infarction, and vascular death increased by quartile of plaque area: 5.6%, 10.7%, 13.9%, and 19.5%, respectively (P<0.001) after adjustment for all baseline patient characteristics. A total of 1085 patients had >/=1 annual carotid plaque area measurements: 685 (63.1%) had carotid plaque progression, 306 (28.2%) had plaque regression, and 176 (16.2%) had no change in carotid plaque area over the period of follow-up. The 5-year adjusted risk of combined outcome was 9.4%, 7.6%, and 15.7% for patients with carotid plaque area regression, no change, and progression, respectively (P=0.003).
Carotid plaque area and progression of plaque identified high-risk patients. Plaque measurement may be useful for targeting preventive therapy and evaluating new treatments and response to therapy and may improve cost-effectiveness of secondary preventive treatment.
通过超声测量颈动脉斑块面积（所观察到的所有斑块纵切面的横截面积），以此作为识别中风、心肌梗死和血管性死亡风险增加患者的一种方法。
对来自动脉粥样硬化预防诊所的患者进行长达5年的年度随访（平均2.5±1.3年），记录基线和随访测量数据。斑块面积进展（或消退）定义为相较于基线增加（或减少）≥0.05平方厘米。
1686例患者的颈动脉斑块面积被分为4个四分位数范围：0.00至0.11平方厘米（n = 422）、0.12至0.45平方厘米（n = 424）、0.46至1.18平方厘米（n = 421）以及1.19至6.73平方厘米（n = 419）。在对所有患者基线特征进行调整后，中风、心肌梗死和血管性死亡的5年综合风险随斑块面积四分位数增加：分别为5.6%、10.7%、13.9%和19.5%（P<0.001）。共有1085例患者进行了≥1次年度颈动脉斑块面积测量：685例（63.1%）有颈动脉斑块进展，306例（28.2%）有斑块消退，176例（16.2%）在随访期间颈动脉斑块面积无变化。对于颈动脉斑块面积消退、无变化和进展的患者，5年调整后的综合结局风险分别为9.4%、7.6%和15.7%（P = 0.003）。
颈动脉斑块面积及斑块进展可识别高危患者。斑块测量可能有助于确定预防性治疗目标、评估新治疗方法及治疗反应，并可能提高二级预防治疗的成本效益。
