Gonzalez-Juanatey Carlos, Llorca Javier, Martin Javier, Gonzalez-Gay Miguel A
Division of Cardiology, Hospital Xeral-Calde, Lugo, Spain.
Semin Arthritis Rheum. 2009 Apr;38(5):366-71. doi: 10.1016/j.semarthrit.2008.01.012. Epub 2008 Mar 12.
To establish whether carotid intima-media wall thickness (IMT) may be a good predictor for the development of cardiovascular (CV) events in patients with rheumatoid arthritis (RA).
A series of 47 RA patients who at the time of recruitment did not have traditional CV risk factors or CV disease were assessed by carotid ultrasonography. Carotid IMT and carotid plaques were measured in the right common carotid artery. Then, a prospective assessment of the CV outcome was performed over a 5-year period. Logistic regression models and receiver operating characteristic curves were performed to evaluate the ability of different variables to predict CV events.
Carotid IMT was greater in RA patients who over the extended follow-up experienced CV events (1.01 +/- 0.16 mm) compared with the remaining RA patients who did not have CV complications (0.74 +/- 0.12 mm) (P < 0.001). Also, carotid IMT categorized in quartiles was strongly associated with CV events. In this regard, none of the patients with carotid IMT less than 0.77 mm had CV events. However, 6 of the 10 patients with carotid IMT greater than 0.91 mm experienced CV events (P value for the trend <0.001). Carotid IMT yielded a high predictive power for the development of CV events over the 5-year follow-up period. The area under the receiver operating characteristic curve was 0.93 for a model that only included carotid IMT and 0.90 for carotid plaque.
The results from the present study support the use of carotid ultrasonography as a predictor of CV events in RA.
确定类风湿关节炎（RA）患者的颈动脉内膜中层厚度（IMT）是否可作为心血管（CV）事件发生的良好预测指标。
对47例在招募时无传统CV危险因素或CV疾病的RA患者进行颈动脉超声检查。测量右侧颈总动脉的颈动脉IMT和颈动脉斑块。然后，在5年期间对CV结局进行前瞻性评估。采用逻辑回归模型和受试者工作特征曲线来评估不同变量预测CV事件的能力。
在延长随访期内发生CV事件的RA患者的颈动脉IMT（1.01±0.16mm）高于未发生CV并发症的其余RA患者（0.74±0.12mm）（P<0.001）。此外，按四分位数分类的颈动脉IMT与CV事件密切相关。在这方面，颈动脉IMT小于0.77mm的患者均未发生CV事件。然而，颈动脉IMT大于0.91mm的10例患者中有6例发生了CV事件（趋势P值<0.001）。在5年随访期内，颈动脉IMT对CV事件的发生具有较高的预测能力。仅包含颈动脉IMT的模型的受试者工作特征曲线下面积为0.93，颈动脉斑块的为0.90。
本研究结果支持将颈动脉超声检查作为RA患者CV事件的预测指标。
