Steinmetz A, Schmitt W, Schuler P, Kleinsorge F, Schneider J, Kaffarnik H
Abteilung Endokrinologie und Stoffwechsel, Philipps Universität, Marburg, F.R.G.
Atherosclerosis. 1988 Dec;74(3):231-9. doi: 10.1016/0021-9150(88)90242-0.
Tendon xanthoma are a hallmark of familial hypercholesterolemia and are among its earliest clinical manifestations. Achilles tendon size, advanced to a generally accepted marker, is virtually specific for the disease and easily accessible for measurement. Hypercholesterolemic patients with coronary heart disease have been reported to have larger diameters of the Achilles tendons than patients without coronary problems. Furthermore, Achilles tendon xanthomas have been shown to regress with treatment of the lipid disorder. Mainly radiological procedures were applied in the past to evaluate the diameters of the Achilles tendon but their use is limited by radiation protection. We have used real-time ultrasonography to evaluate the Achilles tendons of 38 patients with primary hypercholesterolemia and 32 normocholesterolemic controls. The anterior posterior diameter in the patients was 13.4 +/- 5.9 mm (range 6-20 mm) and 5.7 +/- 0.7 mm (range 5-8 mm) in the control group. In 8 patients with newly diagnosed and previously untreated hypercholesterolemia the thickness correlated highly with their age. The Achilles tendons in about half of the patients (n = 21) showed a homogeneous thickening, whereas the others revealed an inhomogeneous thickening indicating the presence of circumscribed xanthoma. Upon comparison of the ultrasonographic procedure with an established method (computed tomography) in 18 patients and 8 normal volunteers a highly significant correlation (r = 0.96) proved the validity of the sonography. We show that real time ultrasonography is a valid procedure to assess Achilles tendon diameters in patients with primary hypercholesterolemia. It can be applied frequently and may be useful to follow xanthoma regression during lipid lowering treatment.
肌腱黄色瘤是家族性高胆固醇血症的标志，也是其最早的临床表现之一。跟腱大小已成为一个普遍认可的指标，实际上对该疾病具有特异性，且易于测量。据报道，患有冠心病的高胆固醇血症患者的跟腱直径比没有冠心病问题的患者更大。此外，已证明跟腱黄色瘤会随着脂质紊乱的治疗而消退。过去主要采用放射学方法来评估跟腱直径，但由于辐射防护问题，其应用受到限制。我们使用实时超声检查来评估38例原发性高胆固醇血症患者和32例正常胆固醇水平对照者的跟腱。患者的前后径为13.4±5.9毫米（范围6 - 20毫米），对照组为5.7±0.7毫米（范围5 - 8毫米）。在8例新诊断且未经治疗的高胆固醇血症患者中，跟腱厚度与年龄高度相关。约一半患者（n = 21）的跟腱呈现均匀增厚，而其他患者则显示不均匀增厚，提示存在局限性黄色瘤。在18例患者和8名正常志愿者中，将超声检查方法与既定方法（计算机断层扫描）进行比较，高度显著的相关性（r = 0.96）证明了超声检查的有效性。我们表明，实时超声检查是评估原发性高胆固醇血症患者跟腱直径的有效方法。它可以频繁应用，并且可能有助于在降脂治疗期间跟踪黄色瘤的消退情况。
