Department of Metabolic Medicine, Osaka University Graduate School of Medicine.
Department of Metabolism and Atherosclerosis, Osaka University Graduate School of Medicine.
J Atheroscler Thromb. 2018 Oct 1;25(10):1053-1066. doi: 10.5551/jat.43141. Epub 2018 Feb 14.
It remains unclear whether measures used in carotid ultrasonography such as the intima-media thickness (IMT) and ultrasonic tissue characterization of the carotid using the gray-scale median (GSM) can add prognostic information beyond the conventional cardiovascular risk markers in patients with diabetes.
This study employed a combined analysis of data obtained in five longitudinal studies including a total of 3263 patients with diabetes but without apparent cardiovascular disease (CVD) at baseline. The associations between carotid ultrasonography measures and the first occurrence of CVD (488 cases), which were defined as cardiovascular death, coronary artery diseases, stroke, or peripheral artery disease, were analyzed.
Common carotid artery (CCA)-mean-IMT, CCA-max-IMT, Max-IMT, plaque-GSM, and the presence of low-GSM echolucent plaques at baseline were prognostic factors for CVD even after adjustment for conventional risk factors. Time-dependent receiver-operating-characteristic (ROC) curve analysis indicated that the use of CCA-mean-IMT, CCA-max-IMT, and Max-IMT in addition to the conventional risk factors improved significantly the prediction of occurrence of CVD. Increments in the CCA-mean-IMT (hazard ratio [HR] 2.37 for every 0.1-mm/year increment [95% confidence interval [CI]: 1.63-3.47], p＜0.001), Max-IMT (HR 1.51 for every 0.1-mm/year increment [95% CI: 1.07-2.14], p=0.020), and Mean-GSM (HR 0.22 for every 10-U/year increment [95% CI: 0.06-0.76], p=0.016) during the observation period were also prognostic factors for CVD even after adjusting for the baseline value of the respective measure.
Addition of carotid ultrasonography measures to conventional risk factors significantly improved the stratification of patients by cardiovascular risk. Changes over time in carotid ultrasonography measures may be used as therapeutic outcome measures.
目前尚不清楚颈动脉超声检查中使用的指标（如内-中膜厚度（IMT）和颈动脉灰阶中位数（GSM）的超声组织特征）是否可以在糖尿病患者中提供比传统心血管风险标志物更具预后意义的信息。
本研究对包括 3263 例基线时无明显心血管疾病（CVD）的糖尿病患者在内的五项纵向研究的数据进行了联合分析。分析了颈动脉超声检查指标与 CVD 首次发生（488 例）的相关性，CVD 定义为心血管死亡、冠状动脉疾病、卒中和外周动脉疾病。
在调整了传统危险因素后，颈总动脉（CCA）平均 IMT、CCA 最大 IMT、最大 IMT、斑块 GSM 和低 GSM 回声斑块的存在仍然是 CVD 的预后因素。时间依赖性受试者工作特征（ROC）曲线分析表明，在使用传统危险因素的基础上，加入 CCA 平均 IMT、CCA 最大 IMT 和最大 IMT 可显著改善 CVD 发生的预测。CCA 平均 IMT 每增加 0.1mm/年（HR 2.37，95%置信区间[CI]：1.63-3.47，p＜0.001）、最大 IMT 每增加 0.1mm/年（HR 1.51，95%CI：1.07-2.14，p=0.020）和平均 GSM 每增加 10U/年（HR 0.22，95%CI：0.06-0.76，p=0.016）与 CVD 之间存在显著相关性，即使在校正各自指标的基线值后也是如此。
在传统危险因素的基础上加入颈动脉超声检查指标可显著改善患者的心血管风险分层。颈动脉超声检查指标随时间的变化可作为治疗效果的指标。
