Gillett Melissa, Davis Wendy A, Jackson Denise, Bruce David G, Davis Timothy M E
University of Western Australia, Department of Medicine, Fremantle Hospital, PO Box 480, Fremantle, Western Australia 6959, Australia.
Stroke. 2003 Sep;34(9):2145-51. doi: 10.1161/01.STR.0000087360.91794.11. Epub 2003 Aug 7.
We sought to examine prospectively the relationship between asymptomatic carotid bruit and stroke in type 2 diabetes.
We studied 1181 (91.3%) of a community-based sample of 1294 patients with type 2 diabetes. These patients had no history of cerebrovascular disease at recruitment during 1993-1996 and were followed until the end of January 2002. Hospital morbidity and death register data relating to cerebrovascular events were also available. Cox proportional hazards models were used to determine whether carotid bruit status was an independent predictor of stroke and to identify other significant cerebrovascular risk factors.
One hundred thirty-four patients (11.3%) suffered a first stroke during 6.5+/-2.2 (mean+/-SD) years of follow-up. In the first 2 years after study entry, first stroke (n=45/1181; 3.8%) was strongly predicted by the presence of carotid bruit(s) after adjustment for known cardiovascular risk factors and other potentially confounding variables (hazard ratio, 6.7; 95% CI, 3.0 to 14.9; P<0.001). Between 2 years and census, first stroke (n=89/1083; 8.2%) was not associated with carotid bruit(s) (P=0.97). Age and diastolic blood pressure were other determinants of stroke in the first 2 years, while age, atrial fibrillation/flutter, and microalbuminuria were independent predictors of subsequent stroke.
Type 2 diabetic patients found to have incidental carotid bruits have >6 times the risk of first stroke in the first 2 years than patients without a bruit and should receive intensified management of vascular risk factors. Carotid imaging with a view to surgical intervention in these patients remains controversial.
我们旨在前瞻性地研究2型糖尿病患者无症状颈动脉杂音与中风之间的关系。
我们对1294例2型糖尿病患者的社区样本中的1181例（91.3%）进行了研究。这些患者在1993 - 1996年招募时无脑血管疾病史，并随访至2002年1月底。还可获得与脑血管事件相关的医院发病率和死亡登记数据。采用Cox比例风险模型来确定颈动脉杂音状态是否为中风的独立预测因素，并识别其他重要的脑血管危险因素。
在6.5±2.2（均值±标准差）年的随访期间，134例患者（11.3%）发生了首次中风。在研究入组后的前2年，在调整已知心血管危险因素和其他潜在混杂变量后，颈动脉杂音的存在强烈预测首次中风（n = 45/1181；3.8%）（风险比，6.7；95%可信区间，3.0至14.9；P<0.001）。在2年至普查期间，首次中风（n = 89/1083；8.2%）与颈动脉杂音无关（P = 0.97）。年龄和舒张压是前2年中风的其他决定因素，而年龄、心房颤动/扑动和微量白蛋白尿是随后中风的独立预测因素。
发现有偶然颈动脉杂音的2型糖尿病患者在最初2年发生首次中风的风险比无杂音患者高6倍以上，应接受强化的血管危险因素管理。对这些患者进行颈动脉成像以便进行手术干预仍存在争议。
