有子痫前期既往史女性的颈动脉内膜中层厚度与亚临床动脉粥样硬化：基于罗切斯特流行病学项目的研究及荟萃分析结果
Carotid Artery Intima-Media Thickness and Subclinical Atherosclerosis in Women With Remote Histories of Preeclampsia: Results From a Rochester Epidemiology Project-Based Study and Meta-analysis.
作者信息
Garovic Vesna D, Milic Natasa M, Weissgerber Tracey L, Mielke Michelle M, Bailey Kent R, Lahr Brian, Jayachandran Muthuvel, White Wendy M, Hodis Howard N, Miller Virginia M
机构信息
Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia.
出版信息
Mayo Clin Proc. 2017 Sep;92(9):1328-1340. doi: 10.1016/j.mayocp.2017.05.030. Epub 2017 Aug 25.
OBJECTIVE
To measure carotid artery intima-media thickness (CIMT), a marker of subclinical atherosclerosis, in postmenopausal women with and without histories of preeclampsia and to synthesize these results with those from prior studies of CIMT performed 10 or more years after preeclamptic pregnancies.
PATIENTS AND METHODS
Forty women (median age, 59 years) with histories of preeclampsia and 40 with histories of normotensive pregnancy (confirmed by medical record review) were selected from women who resided and gave birth in Olmsted County, Minnesota, between January 1, 1976, and December 31, 1982. The participants were identified and recruited in 2014-2015, and CIMT was measured by B-mode ultrasonography. Meta-analysis included CIMT studies that were performed 10 or more years after preeclamptic pregnancies and which were identified through PubMed, EMBASE, and Web of Science. Heterogeneity was assessed using the I statistic. Standardized mean difference was used as a measure of effect size.
RESULTS
Carotid artery intima-media thickness, expressed as a median (interquartile range), was greater in the preeclamptic than in the normotensive group (0.80 mm [0.75-0.85 mm] vs 0.73 mm [0.70-0.78]; P=.004); the odds of having CIMT higher than threshold (0.77 mm) was statistically significant after adjusting for confounding factors (odds ratio, 3.17; 95% CI, 1.10-9.14). A meta-analysis of 10 studies conducted 10 or more years post partum included 813 women with and 2874 without histories of preeclampsia. Carotid artery intima-media thickness was greater among women with histories of preeclampsia, with a standardized mean difference of 0.18 and 95% CI of 0.05 to 0.30 mm (P=.004).
CONCLUSION
Among women with histories of preeclampsia, CIMT may identify those with subclinical atherosclerosis, thus offering an opportunity for early intervention.
目的
测量有和没有子痫前期病史的绝经后女性的颈动脉内膜中层厚度（CIMT），这是亚临床动脉粥样硬化的一个标志物，并将这些结果与子痫前期妊娠后10年或更长时间进行的CIMT先前研究结果进行综合分析。
患者与方法
从1976年1月1日至1982年12月31日期间在明尼苏达州奥尔姆斯特德县居住并分娩的女性中，选取40名有子痫前期病史的女性（中位年龄59岁）和40名有血压正常妊娠病史的女性（通过病历审查确认）。在2014 - 2015年对参与者进行识别和招募，并通过B型超声测量CIMT。荟萃分析纳入了子痫前期妊娠后10年或更长时间进行的CIMT研究，这些研究通过PubMed、EMBASE和科学网进行识别。使用I统计量评估异质性。标准化均数差用作效应量的度量。
结果
以中位数（四分位间距）表示的颈动脉内膜中层厚度，子痫前期组高于血压正常组（0.80毫米[0.75 - 0.85毫米]对0.73毫米[0.70 - 0.78]；P = 0.004）；在调整混杂因素后，CIMT高于阈值（0.77毫米）的几率具有统计学意义（优势比，3.17；95%可信区间，1.10 - 9.14）。对产后10年或更长时间进行的10项研究的荟萃分析包括813名有子痫前期病史的女性和2874名没有子痫前期病史的女性。有子痫前期病史的女性颈动脉内膜中层厚度更大，标准化均数差为0.18，95%可信区间为0.05至0.30毫米（P = 0.004）。
结论
在有子痫前期病史的女性中，CIMT可能识别出有亚临床动脉粥样硬化的患者从而提供早期干预的机会。
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