Seth Sandeep, Goyal Naresh Kumar, Jagia Priya, Gulati Gurpreet, Karthikeyan Ganesan, Sharma S, Talwar K K
Department of Cardiology, Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi-110029, India.
Int J Cardiol. 2006 Apr 14;108(3):385-90. doi: 10.1016/j.ijcard.2005.05.033. Epub 2005 Jun 20.
Assessment of disease activity in patients with Takayasu's arteritis (TA) is difficult due to absence of definitive tests. Presence of carotid intima-medial thickening has been suggested as a possible marker of inflammation and disease activity.
We evaluated common carotid artery carotid intima-medial thickness (CCA-IMT) in 56 common carotid arteries (CCAs) in 28 healthy controls and 74 CCAs in 37 patients of TA. We correlated these findings with the presence of activity as assessed by the National Institutes of Health (NIH) criteria.
CCA-IMT was increased (>0.8 mm) in 59% of the patients with TA. In patients with disease activity, the CCA-IMT was more than in those without activity (1.5+/-0.16 vs. 0.9+/-0.2 mm, P<0.005). This is presumably because of ongoing inflammation causing abnormal thickening. Even among patients without active disease, CCA-IMT was more than in controls (0.9+/-0.2 vs. 0.6+/-0.1 mm, P<0.05) possibly due to a milder degree of inflammation or healing with fibrosis. All patients with angiographic carotid obstruction had increased CCA-IMT irrespective of whether they were active or not. However, in patients with angiographically normal carotid arteries, CCA-IMT was increased only among the patients who were active (1.4+/-0.2 vs. 0.7+/-0.04, P<0.05). Abnormal CCA-IMT as marker of disease activity had a sensitivity of 82% and specificity of 60%. On excluding patients with increased CCA-IMT who had angiographic carotid stenosis (because the increase in CCA-IMT cannot be attributed entirely to activity alone in these patients), the specificity increased to 70%.
Increased CCA-IMT is a reliable marker of active disease, especially in the absence of angiographically visible carotid disease.
由于缺乏确诊检查，大动脉炎（TA）患者疾病活动度的评估较为困难。颈动脉内膜中层增厚被认为可能是炎症和疾病活动的一个标志物。
我们评估了28例健康对照者的56条颈总动脉（CCA）以及37例TA患者的74条CCA的颈总动脉内膜中层厚度（CCA-IMT）。我们将这些结果与根据美国国立卫生研究院（NIH）标准评估的活动度进行了关联分析。
TA患者中59%的患者CCA-IMT增加（>0.8mm）。有疾病活动的患者，其CCA-IMT大于无活动的患者（1.5±0.16 vs. 0.9±0.2mm，P<0.005）。这可能是由于持续炎症导致异常增厚。即使在无活动性疾病的患者中，CCA-IMT也高于对照组（0.9±0.2 vs. 0.6±0.1mm，P<0.05），这可能是由于炎症程度较轻或伴有纤维化愈合。所有血管造影显示颈动脉阻塞的患者，无论其是否处于活动期，CCA-IMT均增加。然而，在血管造影显示颈动脉正常的患者中，只有处于活动期的患者CCA-IMT增加（1.4±0.2 vs. 0.7±0.04，P<0.05）。异常的CCA-IMT作为疾病活动的标志物，敏感性为82%，特异性为60%。排除血管造影显示颈动脉狭窄且CCA-IMT增加的患者（因为这些患者中CCA-IMT的增加不能完全归因于活动）后，特异性提高到70%。
CCA-IMT增加是活动性疾病的可靠标志物，尤其是在血管造影未显示颈动脉疾病的情况下。
