颈动脉粥样硬化疾病可预测血液透析患者的心血管事件：一项前瞻性研究。
Carotid atherosclerotic disease predicts cardiovascular events in hemodialysis patients: a prospective study.
作者信息
Collado Sílvia, Coll Elisabeth, Nicolau Carlos, Pons Mercedes, Cruzado Josep M, Pascual Julio, Cases Aleix
机构信息
Nephrology Department, Hospital del Mar, Barcelona, Spain.
Nephrology Department, Fundació Puigvert, Barcelona, Spain.
出版信息
PLoS One. 2015 Jun 1;10(6):e0127344. doi: 10.1371/journal.pone.0127344. eCollection 2015.
BACKGROUND
To evaluate the predictive value of carotid atherosclerotic disease (CAD) and intima-media thickness (IMT) on incident cardiovascular disease and mortality in hemodialysis patients.
METHODS
Multicenter, observational, prospective study including 110 patients, followed-up to 6 years. Carotid doppler ultrasonographic findings were classified in 4 degrees of severity: 1) IMT <0.9 mm, 2) IMT >0.9 mm, 3) carotid plaque with stenosis <50% and 4) plaque with stenosis >50%. The associations between IMT and CAD and cardiovascular events, total and cardiovascular mortality were assessed.
RESULTS
83% of the patients had atherosclerotic plaques (CAD degrees 3-4). During follow-up, 29.1% of patients experienced cardiovascular events, and 28.2% died, 38.7% of cardiovascular origin. The presence of plaques was associated with cardiovascular events (p = 0.03) while calcified plaques were associated with both cardiovascular events (p = 0.01), cardiovascular mortality (p = 0.03) and non-significantly with overall mortality (p = 0.08) in the survival analysis. Carotid IMT was not associated with outcomes. Cardiovascular events correlated with CAD severity (HR 2.27, 95% CI 1.13-4.54), age (HR 1.04, 1.01-1.06), previous cardiovascular disease (HR 1.75, 1.05-4.42), dyslipidemia (HR 2.25, 1.11-4.53), lipoprotein (a) (HR 1.01, 1.00-1.02), troponin I (HR 3.89, 1.07-14.18), fibrinogen levels (HR 1.38, 0.98-1.94) and antiplatelet therapy (HR 2.14, 1.04-4.4). In an age-adjusted multivariate model, cardiovascular events were independently associated with previous coronary artery disease (HR 3.29, 1.52-7.15) and lipoprotein (a) (HR 1.01, 1.00-1.02).
CONCLUSIONS
The presence of carotid plaques and, especially, calcified plaques, are predictors of new cardiovascular events and cardiovascular mortality in hemodialysis patients, while IMT was not. The prognostic value of calcified plaques should be confirmed in future studies.
背景
评估颈动脉粥样硬化疾病（CAD）和内膜中层厚度（IMT）对血液透析患者发生心血管疾病和死亡率的预测价值。
方法
多中心、观察性、前瞻性研究，纳入110例患者，随访6年。颈动脉多普勒超声检查结果分为4种严重程度：1）IMT<0.9mm，2）IMT>0.9mm，3）伴有狭窄<50%的颈动脉斑块，4）伴有狭窄>50%的斑块。评估IMT与CAD以及心血管事件、全因死亡率和心血管死亡率之间的关联。
结果
83%的患者有动脉粥样硬化斑块（CAD 3 - 4级）。随访期间，29.1%的患者发生心血管事件，28.2%的患者死亡，其中38.7%死于心血管疾病。斑块的存在与心血管事件相关（p = 0.03），而在生存分析中，钙化斑块与心血管事件（p = 0.01）、心血管死亡率（p = 0.03）相关，与全因死亡率无显著相关性（p = 0.08）。颈动脉IMT与结局无关。心血管事件与CAD严重程度（HR 2.27，95%CI 1.13 - 4.54）、年龄（HR 1.04，1.01 - 1.06）、既往心血管疾病（HR 1.75，1.05 - 4.42）、血脂异常（HR 2.25，1.11 - 4.53）、脂蛋白（a）（HR 1.01，1.00 - 1.02）、肌钙蛋白I（HR 3.89，1.07 - 14.18）、纤维蛋白原水平（HR 1.38，0.98 - 1.94）和抗血小板治疗（HR 2.14，1.04 - 4.4）相关。在年龄校正的多变量模型中，心血管事件与既往冠状动脉疾病（HR 3.29，1.52 - 7.15）和脂蛋白（a）（HR 1.01，1.00 - 1.02）独立相关。
结论
颈动脉斑块尤其是钙化斑块的存在是血液透析患者新发心血管事件和心血管死亡率的预测因素，而IMT不是。钙化斑块的预后价值有待未来研究证实。
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