Bots Michiel L, Grobbee Diederick E, Hofman Albert, Witteman Jacqueline C M
Julius Center for Health Sciences and Primary Care, Univeristy Medical Center Utrecht, Utrecht, The Netherlands.
Stroke. 2005 Apr;36(4):762-7. doi: 10.1161/01.STR.0000158924.71069.94. Epub 2005 Mar 3.
It has been argued that lumen diameter of the common carotid artery should be taken into account in analyses on common carotid intima-media thickness (CIMT) and cardiovascular risk. Yet, no published report has dealt with this issue in detail.
In the Rotterdam study baseline ultrasound images of the carotid arteries were made. During follow-up of 8.2 years, 656 new acute myocardial infarctions (AMI) occurred. Regression analysis was used to study myocardial infarction relation to right (or left) common CIMT with various adjustments for right-, or left-sided lumen diameter. Lumen adjustment was made by (1) a simple adjustment in a regression equation; (2) using the CIMT-to-lumen ratio; (3) using arterial mass, calculated as ({pix[(lumen+near wall CIMT+far wall CIMT)/2]2}-[pix(lumen/2)2]).
AMI disease risk increased per standard deviation increase in common CIMT (0.177 mm): hazard ratio (HR) 1.28 (95% CI, 1.19 to 1.37). When lumen diameter was taken into account the HR was 1.26 (95% CI, 1.18 to 1.35). The HR for the CIMT-to-lumen ratio was 1.18 (95% CI, 1.11 to 1.27) and for arterial mass 1.28 (95% CI, 1.19 to 1.37). Additional analyses indicated that the CIMT-to-lumen ratio at lower CIMT levels appears to reflect arterial remodelling rather than risk of cardiovascular disease.
We conclude that using the CIMT-to-lumen ratio yields the weakest associations. Other approaches for adjustment for common carotid lumen diameter do not affect the magnitude or precision of the association of common CIMT to risk of AMI. When the interest is in risk relations the preference goes to either CIMT or arterial mass measurement.
有人认为，在分析颈总动脉内膜中层厚度（CIMT）和心血管风险时应考虑颈总动脉的管腔直径。然而，尚无已发表的报告详细探讨过这一问题。
在鹿特丹研究中，对颈动脉进行了基线超声成像。在8.2年的随访期间，发生了656例新发急性心肌梗死（AMI）。采用回归分析研究心肌梗死与右侧（或左侧）颈总CIMT的关系，并对右侧或左侧管腔直径进行各种调整。管腔调整方法如下：（1）在回归方程中进行简单调整；（2）使用CIMT与管腔的比值；（3）使用动脉质量，计算方法为（{π×[（管腔+近壁CIMT+远壁CIMT）/2]²}-[π×（管腔/2）²]）。
颈总CIMT每增加一个标准差（0.177mm），AMI疾病风险增加：风险比（HR）为1.28（95%置信区间，1.19至1.37）。考虑管腔直径时，HR为1.26（95%置信区间，1.18至1.35）。CIMT与管腔比值的HR为1.18（95%置信区间，1.11至1.27），动脉质量的HR为1.28（95%置信区间，1.19至1.37）。进一步分析表明，在较低CIMT水平下，CIMT与管腔的比值似乎反映的是动脉重塑，而非心血管疾病风险。
我们得出结论，使用CIMT与管腔的比值得出的关联最弱。其他调整颈总动脉管腔直径的方法不会影响颈总CIMT与AMI风险关联的强度或精度。当关注风险关系时，首选CIMT或动脉质量测量。
