颈动脉内膜中层厚度是 2 型糖尿病合并慢性肾脏病患者全因死亡率和心血管发病率的独立预测因子。
Carotid intima-media thickness is an independent predictor of all-cause mortality and cardiovascular morbidity in patients with diabetes mellitus type 2 and chronic kidney disease.
机构信息
a Department of Nephrology , "Democritus" University of Thrace, Medical School, University General Hospital of Alexandroupolis , Alexandroupolis , Greece.
b Department of Vascular Surgery , "Democritus" University of Thrace, Medical School, University General Hospital of Alexandroupolis , Alexandroupolis , Greece.
出版信息
Ren Fail. 2019 Nov;41(1):131-138. doi: 10.1080/0886022X.2019.1585372.
BACKGROUND
Intima-Media-Thickness of the carotid artery wall (cIMT) is a strong predictor of cardiovascular (CV) disease. The aim of this study was to investigate the significance of cIMT as an independent prognostic factor for CV morbidity and mortality in patients with chronic kidney disease (CKD) and diabetes mellitus type 2 (DM2).
METHODS
The study included 142 diabetic patients in different stages of CKD. Patients were categorized into two groups according to low (≤0.86 mm) or high cIMT (>0.86 mm), respectively. CV events and death from all causes were registered during a seven-year follow-up.
RESULTS
Mean age, BMI and duration of diabetes were 68 years (range: 45-90), >30 kg/m and 15 years (range: 5-40), respectively. Patients with increased cIMT were older, suffered from a lower estimated glomerular filtration rate (eGFR), peripheral atherosclerosis and plaque presence in either carotid artery. Increased BMI (beta= -0.29, p = .01), lower eGFR (beta = 0.353, p = .003) and male gender (beta= -0.339, p = .005) were found to predict increased cIMT. Predictors of all-cause mortality in Cox proportional hazard models were low eGFR and high cIMT with HR = 0.96 (CI = 0.94-0.98), p < .001 and HR = 2.9 (CI = 1.03-7.99), p = .04, respectively. The risk of future CV event was determined by albuminuria and cIMT with HR = 1 (CI = 1.0-1.0), p < .001 and HR = 2.04 (CI = 1.1-3.78), p = .02, respectively. Patients with high cIMT presented significantly higher all-cause mortality and a new CV event (p = .005/p = .018, respectively).
CONCLUSIONS
cIMT is a strong and independent predictor of CV morbidity and mortality, and should be considered a valuable tool for the stratification of CV risk in patients with CKD and DM2.
背景
颈动脉壁内膜-中层厚度（cIMT）是心血管疾病（CV）的强有力预测指标。本研究旨在探讨 cIMT 作为慢性肾脏病（CKD）和 2 型糖尿病（DM2）患者 CV 发病率和死亡率的独立预后因素的意义。
方法
该研究纳入了 142 名处于不同 CKD 阶段的糖尿病患者。根据 cIMT 低（≤0.86mm）或高（>0.86mm），将患者分为两组。在 7 年的随访期间，记录 CV 事件和所有原因导致的死亡。
结果
平均年龄（范围：45-90 岁）、BMI（范围：>30kg/m）和糖尿病病程（范围：5-40 年）分别为 68 岁、>30kg/m 和 15 年。cIMT 升高的患者年龄更大，估算肾小球滤过率（eGFR）更低，周围动脉粥样硬化和两侧颈动脉斑块的存在。BMI 降低（β=−0.29，p=0.01）、eGFR 降低（β=0.353，p=0.003）和男性（β=−0.339，p=0.005）与 cIMT 升高相关。Cox 比例风险模型中全因死亡率的预测因子为低 eGFR 和高 cIMT，HR=0.96（CI=0.94-0.98），p<0.001 和 HR=2.9（CI=1.03-7.99），p=0.04。未来 CV 事件的风险由白蛋白尿和 cIMT 决定，HR=1（CI=1.0-1.0），p<0.001 和 HR=2.04（CI=1.1-3.78），p=0.02。cIMT 较高的患者全因死亡率和新发 CV 事件明显更高（p=0.005/p=0.018）。
结论
cIMT 是 CV 发病率和死亡率的强有力且独立的预测指标，应被视为 CKD 和 DM2 患者 CV 风险分层的有价值工具。
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