Fukuhara Toru, Hida Kazuyuki
Division of Neurosurgery, Research Institute for Stroke Care, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Okayama 701-1192, Japan.
J Ultrasound Med. 2006 May;25(5):599-605. doi: 10.7863/jum.2006.25.5.599.
Although carotid intima-media thickness is a well-recognized indicator of atherosclerosis, it may not be an appropriate indicator of microangiopathy. We evaluated the parameters of extracranial carotid artery (CA) duplex ultrasonographic scanning in relation to microalbuminuria, which is an indicator of microangiopathy in patients with diabetes. The relationships of CA stenosis, hypertension, and dyslipidemia with microalbuminuria were also evaluated.
Among 234 patients who were hospitalized for controlling type 2 diabetes during a 20-month period, those with major cerebrovascular, cardiac, or renal disease were excluded, leaving 159 patients who did not have any acute symptoms enrolled in this cross-sectional study. The parameters of extracranial CA duplex ultrasonographic scanning and urine albumin-to-creatinine ratio (u-ACR) were extracted, and their relationships were analyzed. Each patient's status with regard to CA stenosis, hypertension, and dyslipidemia was also examined for the effects on u-ACR.
Of the 159 patients, 29 (18.2%) had some CA stenosis, and there were significantly more hypertensive patients in this group (P=.007). The value of u-ACR was significantly higher in patients with dyslipidemia (P<.001) but not in those with CA stenosis or hypertension. With univariate analysis, significant correlations of u-ACR were observed with age, right end-diastolic velocity, and the bilateral pulsatility index (PI). Among these factors, multivariate analysis was made, and only age and PI proved to be independent factors correlated with u-ACR (P<.0001). With a PI cutoff of 1.15, 89.3% specificity with 49.1% sensitivity was obtained for detecting microalbuminuria.
The PI at the cervical internal CA can indicate microangiopathy because of its strong correlation with microalbuminuria in patients with type 2 diabetes, and it is thought to reflect the microangiopathy of cerebral vessels.
虽然颈动脉内膜中层厚度是动脉粥样硬化一个公认的指标，但它可能不是微血管病变的合适指标。我们评估了颅外颈动脉（CA）双功超声扫描参数与微量白蛋白尿的关系，微量白蛋白尿是糖尿病患者微血管病变的一个指标。还评估了CA狭窄、高血压和血脂异常与微量白蛋白尿的关系。
在20个月期间因控制2型糖尿病而住院的234例患者中，排除患有严重脑血管、心脏或肾脏疾病的患者，159例无任何急性症状的患者纳入本横断面研究。提取颅外CA双功超声扫描参数和尿白蛋白肌酐比值（u-ACR），并分析它们之间的关系。还检查了每位患者的CA狭窄、高血压和血脂异常情况对u-ACR的影响。
159例患者中，29例（18.2%）有某种程度的CA狭窄，该组高血压患者明显更多（P = 0.007）。血脂异常患者的u-ACR值明显更高（P < 0.001），但CA狭窄或高血压患者并非如此。单因素分析显示，u-ACR与年龄、右室舒张末期速度和双侧搏动指数（PI）有显著相关性。在这些因素中进行多因素分析，只有年龄和PI被证明是与u-ACR相关的独立因素（P < 0.0001）。以PI截止值1.15检测微量白蛋白尿时，特异性为89.3%，敏感性为49.1%。
颈内CA处的PI可提示微血管病变，因为它与2型糖尿病患者的微量白蛋白尿密切相关，并且被认为反映了脑血管的微血管病变。
