Tanaka H, Nishino M, Ishida M, Fukunaga R, Sueyoshi K
Department of Internal Medicine, Osaka Rosai Hospital, Japan.
Stroke. 1992 Jul;23(7):946-51. doi: 10.1161/01.str.23.7.946.
Along with the recent changes in lifestyle in Japan, the incidence of coronary artery disease has increased while the incidence of stroke appears to be decreasing. We investigated the relation between the progression of carotid atherosclerosis and the severity of coronary artery disease in the Japanese population.
The 2-year change in extracranial carotid atherosclerosis in 50 Japanese patients who underwent coronary angiography was evaluated using carotid echotomography. To quantify the extent of carotid atherosclerosis, the maximal thickness measurements of all plaques were summed for an individual plaque score, except for new plaques found on reexamination. Carotid disease progression was evaluated by the sum of plaque score change and the thickness of the new plaque found on reexamination.
The plaque score changed by -3.2 to 10.1 mm (mean +/- SD, 1.06 +/- 2.42 mm). The extent of coronary atherosclerosis (p less than 0.02) and serum total cholesterol level (p less than 0.01) were different between the progressing (n = 17) and the nonprogressing (n = 30) groups of carotid atherosclerosis when the progressing group included the patients with a delta plaque score of greater than or equal to 1.0 mm. Neither age, serum triglyceride level, serum high-density lipoprotein cholesterol level, pack-years of smoking, percentage of smokers, percentage of hypertensive patients, nor percentage of diabetic patients was different between the two groups. Carotid disease progression was significantly higher in patients with three-vessel coronary disease than in patients without significant coronary artery disease (p less than 0.005). There was a significant positive linear correlation between carotid disease progression and Gensini's coronary artery disease score (R = 0.411, p less than 0.005).
Our data showed that severe coronary artery disease and a high serum total cholesterol level were strong predictors for carotid disease progression in Japanese patients with high rates of coronary artery disease.
随着日本近期生活方式的改变，冠状动脉疾病的发病率有所上升，而中风的发病率似乎在下降。我们调查了日本人群中颈动脉粥样硬化进展与冠状动脉疾病严重程度之间的关系。
对50例接受冠状动脉造影的日本患者，采用颈动脉超声断层扫描评估其颅外颈动脉粥样硬化的2年变化情况。为了量化颈动脉粥样硬化的程度，将所有斑块的最大厚度测量值相加得出个体斑块评分，但重新检查时发现的新斑块除外。通过斑块评分变化之和以及重新检查时发现的新斑块厚度来评估颈动脉疾病的进展情况。
斑块评分变化范围为-3.2至10.1毫米（均值±标准差，1.06±2.42毫米）。当进展组包括斑块评分变化量大于或等于1.0毫米的患者时，颈动脉粥样硬化进展组（n = 17）和非进展组（n = 30）之间的冠状动脉粥样硬化程度（p < 0.02）和血清总胆固醇水平（p < 0.01）存在差异。两组之间的年龄、血清甘油三酯水平、血清高密度脂蛋白胆固醇水平、吸烟包年数、吸烟者百分比、高血压患者百分比以及糖尿病患者百分比均无差异。三支血管冠状动脉疾病患者的颈动脉疾病进展显著高于无明显冠状动脉疾病的患者（p < 0.005）。颈动脉疾病进展与Gensini冠状动脉疾病评分之间存在显著的正线性相关（R = 0.411，p < 0.005）。
我们的数据表明，在冠状动脉疾病发病率较高的日本患者中，严重的冠状动脉疾病和高血清总胆固醇水平是颈动脉疾病进展的强有力预测因素。
