Hirai Keiji, Imamura Shigeki, Hirai Aizan, Misumi Kazuo, Ookawara Susumu, Morishita Yoshiyuki
Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
Department of Internal Medicine, Chiba Cerebral and Cardiovascular Center, Chiba, Japan.
Ther Clin Risk Manag. 2018 Aug 13;14:1407-1416. doi: 10.2147/TCRM.S168926. eCollection 2018.
This study investigated the factors associated with coronary artery stenosis in outpatients. Furthermore, the usefulness of maximum carotid intima-media thickness (maximum-IMT) as a surrogate marker of coronary artery stenosis was evaluated.
We conducted a single-center retrospective study. A total of 601 outpatients (338 males; 263 females; mean age, 69.8±10.0 years) who underwent coronary computed tomography angiography between April 2006 and March 2012 were analyzed. The associations between coronary artery stenosis (≥75%) as determined by coronary computed tomography angiography and clinical and laboratory parameters were evaluated by multivariate logistic regression. Validation of maximum-IMT as measured by ultrasonography as a surrogate marker of coronary artery stenosis was analyzed by receiver operating characteristic (ROC) curve analysis.
The estimated glomerular filtration rate (eGFR: mL/min/1.73 m) (odds ratio [OR] 0.985, <0.01), diabetes mellitus (OR 1.98, <0.05), and maximum-IMT (mm) (OR 1.76, <0.01) were significantly associated with coronary artery stenosis (≥75%). In analysis of each group categorized by identified factors, such as renal impairment (eGFR <60 mL/min/1.73 m) and diabetes mellitus, the ROC curve of maximum-IMT was significant in the group of patients with diabetes mellitus without renal impairment (<0.01) (cutoff value of maximum-IMT, 2.0 mm; sensitivity, 0.74; and specificity, 0.54) but not in other groups.
Renal impairment, diabetes mellitus, and increased maximum-IMT may be significant risk factors of coronary artery stenosis. Maximum-IMT as measured by ultrasonography may be a useful surrogate marker for coronary artery stenosis in patients with diabetes mellitus without renal impairment but not in other patients.
本研究调查了门诊患者冠状动脉狭窄的相关因素。此外，评估了最大颈动脉内膜中层厚度（最大IMT）作为冠状动脉狭窄替代标志物的有效性。
我们进行了一项单中心回顾性研究。分析了2006年4月至2012年3月期间接受冠状动脉计算机断层扫描血管造影的601例门诊患者（男性338例；女性263例；平均年龄69.8±10.0岁）。通过多因素逻辑回归评估冠状动脉计算机断层扫描血管造影确定的冠状动脉狭窄（≥75%）与临床和实验室参数之间的关联。通过受试者操作特征（ROC）曲线分析评估超声测量的最大IMT作为冠状动脉狭窄替代标志物的有效性。
估计肾小球滤过率（eGFR：mL/min/1.73 m²）（比值比[OR]0.985，P<0.01）、糖尿病（OR 1.98，P<0.05）和最大IMT（mm）（OR 1.76，P<0.01）与冠状动脉狭窄（≥75%）显著相关。在按已确定因素（如肾功能损害（eGFR<60 mL/min/1.73 m²）和糖尿病）分类的每组分析中，最大IMT的ROC曲线在无肾功能损害的糖尿病患者组中具有显著性（P<0.01）（最大IMT的截断值为2.0 mm；敏感性为0.74；特异性为0.54），但在其他组中无显著性。
肾功能损害、糖尿病和最大IMT增加可能是冠状动脉狭窄的重要危险因素。超声测量的最大IMT可能是无肾功能损害的糖尿病患者冠状动脉狭窄的有用替代标志物，但在其他患者中并非如此。
