Fabbian F, Cacici G, Franceschini L, Russo G, Vassanelli C, Catizone L, Lupo A
Department of Nephrology, St Anna Hospital, Ferrara - Italy.
Int J Artif Organs. 2007 Apr;30(4):315-20. doi: 10.1177/039139880703000406.
Data relating carotid ultrasound (CU) to atherosclerotic damage evaluated by coronary angiography in hemodialysis patients are scarce.
We carried out a cross-sectional study in 33 uremic subjects (age 55 +/- 12 years, 22 male, 7 diabetic), who have been on dialysis for 41 +/- 48 months (range 2-192). Twenty-two underwent a coronary angiography in order to complete clinical evaluation for inclusion on the kidney transplantation waiting list, and 11 because of coronary artery disease (CAD); Gensini's score was calculated. Intima-media thickness (IMT) and presence of plaques were related to the degree of coronary stenosis and to cardiovascular risk factors. Patients were divided into two groups depending on mean IMT (group 1 IM <or= 0.9 mm, n=18; group 2 IMT>0.9 mm, n=15).
Group 2 was older (60 +/- 8 vs 50 +/- 12 year, p=0.01), had higher frequency of CAD (53 vs 16%, p=0.02) and had higher prevalence of coronary artery stenosis >or= 75% in the right (60 vs 22%, p=0.02), left anterior descending (46 vs 16%, p=0.06) and left circumflex coronary arteriers (60 vs 11%, p=0.05) than group 1. IMT was not related to the degree of CAD evaluated by Gensini's score. IMT sensibility and specificity in detecting the presence of hemodynamically significant coronary stenosis were 64% and 68%, respectively. Coronary narrowing was correlated with the degree of stenosis of common, internal and external carotid arteries (Spearman's rank correlation coefficient). During two years of follow-up, six major cardiac events were recorded and they were related to Gensini's score.
In uremic patients, ultrasonographic evaluation of carotid arteries is a simple, noninvasive examination that could be a helpful tool in detecting coronary atherosclerotic damage, but IMT does not appear to add more information regarding risk stratification of CAD.
关于血液透析患者中颈动脉超声（CU）与通过冠状动脉造影评估的动脉粥样硬化损伤之间关系的数据很少。
我们对33名尿毒症患者（年龄55±12岁，男性22名，糖尿病患者7名）进行了一项横断面研究，这些患者已接受透析41±48个月（范围2 - 192个月）。22名患者接受冠状动脉造影以完成纳入肾脏移植等待名单的临床评估，11名患者因冠状动脉疾病（CAD）接受造影；计算了Gensini评分。内膜中层厚度（IMT）和斑块的存在与冠状动脉狭窄程度及心血管危险因素相关。根据平均IMT将患者分为两组（第1组IMT≤0.9 mm，n = 18；第2组IMT>0.9 mm，n = 15）。
第2组患者年龄更大（60±8岁对50±12岁，p = 0.01），CAD发生率更高（53%对16%，p = 0.02），并且右冠状动脉（60%对22%，p = 0.02）、左前降支（46%对16%，p = 0.06）和左旋支冠状动脉（60%对11%，p = 0.05）中冠状动脉狭窄≥75%的患病率高于第1组。IMT与通过Gensini评分评估的CAD程度无关。IMT检测血流动力学显著冠状动脉狭窄存在的敏感性和特异性分别为64%和68%。冠状动脉狭窄与颈总动脉、颈内动脉和颈外动脉的狭窄程度相关（Spearman等级相关系数）。在两年的随访期间，记录了6次主要心脏事件，且这些事件与Gensini评分相关。
在尿毒症患者中，颈动脉超声评估是一种简单、无创的检查，可能是检测冠状动脉粥样硬化损伤的有用工具，但IMT似乎并未为CAD风险分层增加更多信息。
