Friedlander Arthur H, Graves Lindsay L, Grabich Shannon G, Aghazadehsanai Nona, Chang Tina I
1 Graduate Medical Education Service, Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
2 Oral and Maxillofacial Surgery Service at the Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
Dentomaxillofac Radiol. 2017 Jul;46(5):20160406. doi: 10.1259/dmfr.20160406. Epub 2017 Mar 28.
Given the enhanced risk of ischaemic stroke resulting from the direct effects of hyperuricaemia on vascular plaque formation seen among older males with gout, we sought to determine the prevalence of calcified carotid artery atheromas (CCAAs) on their panoramic images (PIs).
Medical record librarians identified all male patients over 45 years, who had a diagnosis of gout and a PI incidentally obtained between 2000 and 2015. The prevalence rate of CCAA on technically appropriate images was determined, as were these patients' atherogenic risk profiles including: age, body mass index, hypertension and dyslipidaemia. Comparisons of atherogenic risk factors were made between this cohort and those without CCAA.
Of the 531 patients with gout, 163 patients were adjudicated to be CCAA+ (the panoramic image demonstrates a calcified carotid artery atheroma). Logistic regression analysis demonstrated that a comorbid diagnosis of diabetes mellitus or dyslipidaemia, or advancing age was determinant in differentiating patients who were CCAA+ vs those who were CCAA- (the panoramic image does not demonstrate a calcified carotid artery atheroma).
CCAAs often herald an ischaemic stroke and may be seen on the PIs of patients with gout, especially those with increased age, dyslipidaemia or diabetes. Thus, dentists must be uniquely vigilant in detecting these lesions when evaluating the images of all patients with gout, especially those with additional positive risk factors.
鉴于高尿酸血症对痛风老年男性血管斑块形成的直接影响会增加缺血性中风的风险，我们试图确定其全景图像（PI）上钙化颈动脉粥样硬化斑块（CCAA）的患病率。
病历管理员识别出所有45岁以上、诊断为痛风且在2000年至2015年间偶然获得PI的男性患者。确定技术上合适的图像上CCAA的患病率，以及这些患者的动脉粥样硬化风险概况，包括：年龄、体重指数、高血压和血脂异常。对该队列与无CCAA的患者的动脉粥样硬化风险因素进行比较。
在531例痛风患者中，163例被判定为CCAA阳性（全景图像显示有钙化颈动脉粥样硬化斑块）。逻辑回归分析表明，糖尿病或血脂异常的合并诊断或年龄增长是区分CCAA阳性患者与CCAA阴性患者（全景图像未显示钙化颈动脉粥样硬化斑块）的决定因素。
CCAA常预示着缺血性中风，在痛风患者的PI上可能可见，尤其是年龄较大、血脂异常或患有糖尿病的患者。因此，牙医在评估所有痛风患者的图像时，尤其是那些有其他阳性风险因素的患者，必须特别警惕检测这些病变。
