Frerix Marc, Stegbauer Johannes, Kreuter Alexander, Weiner Stefan Markus
Arthritis Res Ther. 2014 Feb 19;16(1):R54. doi: 10.1186/ar4489.
The objective of this cross-sectional and retrospective cohort study was (1) to determine the usefulness of intima-media thickness (IMT) in contrast to plaque assessment, (2) to examine the value of additive femoral artery sonography and (3) to identify potential risk factors for atherosclerosis and incident cardiovascular events in systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) patients.
In this study, 90 SSc and 100 SLE patients were examined by duplexsonography. IMT was measured in common carotid and common femoral arteries, plaques were assessed in common, internal and external carotid and common, proximal superficial and deep femoral arteries. Different definitions of pathological IMT (pIMT) were compared with the presence of plaque. Results were evaluated in relation to traditional and non-traditional risk factors for baseline atherosclerosis (logistic regression) and their predictive value for cardiovascular events during follow-up (cox regression).
Definite atherosclerosis occurred frequently without signs of subclinical atherosclerosis in both diseases: pIMT >0.9 mm was present in only 17/59 (28.9%) SSc and 13/49 (26.5%) SLE patients with already present atherosclerotic plaques. Using age-adjusted pIMT definitions, this rate was even lower (5.1-10.3% in SSc, 14.3-26.5% in SLE). Plaques were located only at the carotid or only at the femoral arteries in 26 (13.7%) and 24 (12.6%) patients, respectively. Age and nicotine pack-years were independently associated with atherosclerotic plaques in SLE and SSc patients, as well as the cumulative prednisolone dose in SSc subgroup, and ssDNA positive SLE patients had a lower risk for atherosclerotic plaque. During follow-up (available for 129/190 (67.9%) patients, 650 person-years), cardiovascular events occurred more often in patients with coronary heart disease (adjusted-hazards ratio (HR) 10.19, 95% confidence interval (CI) 3.04 to 34.17, P <0.001), male patients (adjusted-HR 8.78, 95% CI 2.73 to 28.19, P <0.001) and in patients with coexistent carotid and femoral plaques (adjusted-HR 5.92, 95% CI 1.55 to 22.67, P = 0.009). Patients with solely carotid or femoral plaque were not at higher risk.
Atherosclerotic plaque lesions can be found frequently in absence of intima-media thickening in both SSc and SLE patients. As well as routine sonography of carotid arteries, the sonography of femoral arteries is recommended to identify additional atherosclerotic lesions and to detect patients at a high risk for cardiovascular events.
这项横断面回顾性队列研究的目的是：（1）确定与斑块评估相比，内膜中层厚度（IMT）的作用；（2）检验股动脉超声检查的附加价值；（3）识别系统性硬化症（SSc）和系统性红斑狼疮（SLE）患者动脉粥样硬化及心血管事件的潜在危险因素。
本研究中，90例SSc患者和100例SLE患者接受了双功超声检查。测量颈总动脉和股总动脉的IMT，评估颈总、颈内、颈外动脉以及股总、股浅、股深动脉近端的斑块情况。将不同的病理性IMT（pIMT）定义与斑块的存在情况进行比较。根据基线动脉粥样硬化的传统和非传统危险因素（逻辑回归）及其对随访期间心血管事件的预测价值（cox回归）对结果进行评估。
在这两种疾病中，明确的动脉粥样硬化常无亚临床动脉粥样硬化的迹象：在已有动脉粥样硬化斑块的SSc患者中，仅17/59例（28.9%）pIMT>0.9mm，SLE患者中为13/49例（26.5%）。采用年龄校正的pIMT定义时，该比例更低（SSc患者为5.1-10.3%，SLE患者为14.3-26.5%）。分别有26例（13.7%）和24例（12.6%）患者的斑块仅位于颈动脉或仅位于股动脉。年龄和吸烟包年数与SLE和SSc患者的动脉粥样硬化斑块独立相关，SSc亚组中累积泼尼松龙剂量也与之相关，抗双链DNA阳性的SLE患者发生动脉粥样硬化斑块的风险较低。在随访期间（129/190例（67.9%）患者，共650人年），冠心病患者发生心血管事件的频率更高（校正风险比（HR）为10.19，95%置信区间（CI）为3.04至34.17，P<0.001），男性患者（校正HR为8.78，95%CI为2.73至28.19，P<0.001）以及同时存在颈动脉和股动脉斑块的患者（校正HR为5.92，95%CI为1.55至22.67，P=0.009）。仅存在颈动脉或股动脉斑块的患者风险并未增加。
在SSc和SLE患者中，常可发现动脉粥样硬化斑块病变而无内膜中层增厚。除了常规的颈动脉超声检查外，建议进行股动脉超声检查以发现更多的动脉粥样硬化病变，并检测心血管事件高危患者。
