Shai Efrati, Siegal Sadetzki, Michael Zaretsky, Itzhak Kimiagar, Ronen Rosenblum, Dror Marchaim, Sylvia Berman, Adina Bar-Haim, Ramzia Abu Hamad, Marina Feigenzon, Angela Chetrit, Dov Yassky, Joshua Weissgarten, Arie Bass
Research & Development Unit, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Atherosclerosis. 2009 Jun;204(2):556-60. doi: 10.1016/j.atherosclerosis.2008.09.030. Epub 2008 Oct 8.
During the first half of the 20th century, scalp irradiation was a standard treatment for children suffering from Tinea Capitis. These children are now more than 50 years old, reaching the age when manifestations of atherosclerosis are common. We investigated the possible association between childhood low dose scalp irradiation and development of carotid atherosclerosis in adulthood.
The study included 145 individuals treated by irradiation in their childhood, and 150 matched control subjects with no history of irradiation. The occurrence of stroke was disregarded during the inclusion. B-mode ultrasound imaging and US Doppler were used to measure carotid, femoral (distant from the radiated area) and intima media thickness (IMT). Blood lipids and homocysteine were also evaluated.
No significant differences in the baseline patients' characteristics were observed. There were no differences in incidence of femoral IMT or prevalence of femoral stenosis between the groups. However, in the carotid of the irradiated group, a significantly elevated IMT and significantly increased prevalence of carotid stenosis were observed (p<0.001). In the irradiated group, 30.3% and 39.3% had stenosis in the right or left carotid arteries, compared to 12.7% and 16% in controls(p<0.001), adjusted OR=5.36[CI:2.78-10.33]. More participants in the irradiated group had experienced ischemic stroke: 13 patients (9%) from the irradiated group vs. 3 patients(2%) from the non-exposed group, p=0.01.
Childhood scalp irradiation is a significant and thus far underestimated risk factor for adult carotid atherosclerosis disease. Physicians should be aware of the existence of such high risk populations.
在20世纪上半叶，头皮照射是患有头癣儿童的标准治疗方法。这些儿童现在已超过50岁，已到动脉粥样硬化表现常见的年龄。我们研究了儿童期低剂量头皮照射与成年期颈动脉粥样硬化发展之间的可能关联。
该研究纳入了145名童年时期接受过照射治疗的个体，以及150名无照射史的匹配对照对象。纳入时不考虑中风的发生情况。使用B型超声成像和超声多普勒测量颈动脉、股动脉（远离辐射区域）和内膜中层厚度（IMT）。还评估了血脂和同型半胱氨酸。
在患者基线特征方面未观察到显著差异。两组之间股动脉IMT发生率或股动脉狭窄患病率没有差异。然而，在接受照射组的颈动脉中，观察到IMT显著升高且颈动脉狭窄患病率显著增加（p<0.001）。在接受照射组中，右侧或左侧颈动脉狭窄的比例分别为30.3%和39.3%，而对照组为12.7%和16%（p<0.001），调整后的OR=5.36[CI：2.78 - 10.33]。接受照射组中有更多参与者经历过缺血性中风：照射组有13名患者（9%），未暴露组有3名患者（2%），p = 0.01。
儿童期头皮照射是成人颈动脉粥样硬化疾病的一个重要且迄今为止被低估的危险因素。医生应意识到这类高危人群的存在。
