Sirico Giusy, Brevetti Gregorio, Lanero Simona, Laurenzano Eugenio, Luciano Rossella, Chiariello Massimo
Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University of Naples Federico II, Naples, Italy.
J Vasc Surg. 2009 Feb;49(2):346-51. doi: 10.1016/j.jvs.2008.09.019. Epub 2008 Nov 22.
Plaque instability is recognized as a multivessel phenomenon related to inflammation. This study examined if the morphology of femoral plaques was related to that of carotid plaques.
The echogenicity of femoral and carotid plaques of 102 patients with peripheral artery disease (PAD) was studied and classified as echolucent or echorich according to the gray-scale median (GSM) value, which was 53.6 for femoral plaques and 55.2 for carotid plaques. Serum C-reactive protein (CRP) levels and neutrophil count were also measured.
Echolucent carotid plaques were more frequent in patients with echolucent than in those with echorich femoral plaques (55.8% vs 32.0%; P < .01). At multivariate analysis, femoral GSM lower than the median was the only significant predictor of echolucent carotid plaques (odds ratio [OR], 3.87; 95% confidence interval [CI], 1.53-9.83). Patients with echolucent femoral plaques had higher serum CRP levels (P < .01) and a higher neutrophil count (P = .029) than patients with echorich femoral plaques. However, univariate analysis showed that neutrophil count (OR, 3.48; 95% CI, 1.23-9.85) but not hs-CRP was associated with echolucent carotid plaques. At multivariate analysis, neutrophil count exceeding the median remained associated with echolucent carotid plaques (OR, 5.71; 95% CI, 1.37-23.85), whereas the association between femoral and carotid echolucency was attenuated (OR, 3.75; 95% CI, 0.98-4.43).
In PAD, the presence of echolucent femoral plaques is associated with a greater prevalence of echolucent carotid plaques, probably as a consequence of a more pronounced inflammatory profile. This confirms and extends the finding that plaque echolucency is a multivessel phenomenon. Prospective studies are needed to assess whether carotid screening in PAD patients might contribute to improving clinical decision-making.
斑块不稳定性被认为是一种与炎症相关的多血管现象。本研究探讨股动脉斑块形态是否与颈动脉斑块形态相关。
对102例外周动脉疾病（PAD）患者的股动脉和颈动脉斑块的回声性进行研究，并根据灰度中位数（GSM）值分为无回声或高回声，股动脉斑块的GSM值为53.6，颈动脉斑块的GSM值为55.2。同时检测血清C反应蛋白（CRP）水平和中性粒细胞计数。
无回声股动脉斑块患者中无回声颈动脉斑块比高回声股动脉斑块患者更常见（55.8%对32.0%；P<.01）。多因素分析显示，低于中位数的股动脉GSM是无回声颈动脉斑块的唯一显著预测因素（优势比[OR]，3.87；95%置信区间[CI]，1.53 - 9.83）。无回声股动脉斑块患者的血清CRP水平更高（P<.01），中性粒细胞计数也更高（P =.029）。然而，单因素分析显示中性粒细胞计数（OR，3.48；95%CI，1.23 - 9.85）而非高敏CRP与无回声颈动脉斑块相关。多因素分析中，超过中位数的中性粒细胞计数仍与无回声颈动脉斑块相关（OR，5.71；95%CI，1.37 - 23.85），而股动脉和颈动脉无回声之间的关联减弱（OR，3.75；95%CI，0.98 - 4.43）。
在PAD中，无回声股动脉斑块的存在与无回声颈动脉斑块的更高患病率相关，这可能是更明显炎症特征的结果。这证实并扩展了斑块无回声是一种多血管现象的发现。需要进行前瞻性研究以评估对PAD患者进行颈动脉筛查是否有助于改善临床决策。
