Unité d'Exploration et de médecine vasculaires, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
Unité d'Exploration et de médecine vasculaires, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
J Med Vasc. 2021 Apr;46(2):66-71. doi: 10.1016/j.jdmv.2021.02.002. Epub 2021 Mar 6.
Patients exposed to nilotinib for chronic myeloid leukemia (CML) appear to be at risk of arterial complication. The prevalence and aspect of ultrasound asymptomatic arterial lesions are unknown.
To describe prevalence and characteristics of ultrasound arterial anomalies in patients treated with nilotinib for CML.
Patients treated with nilotinib from 2006 to 2015 in the department of the Paoli-Calmettes Institute, Marseille, were included retrospectively. A vascular ultrasound screening was carried out from 2010. The arterial lesions at the first examination were described: plaque and its echogenicity, stenosis or occlusion. A vascular arterial anomaly (VAA) was defined by the presence of a clinical and/or ultrasound anomaly. Patients with or without VAA at initial vascular examination were compared using bivariate and multivariate analysis.
74 patients were included (51.4% men, mean age 54.5 years); 25 patients had ultrasound arterial anomalies (33.8%). Carotid bulb was the most involved territory (44%). Arterial anomalies were: 88% plaques, 44%>50% stenosis and 12% occlusion. 72.7% plaques were echolucent or hypoechogenic. A VAA was present in 25 patients with initial vascular evaluation (33.8%). Patients with VAA at baseline were significantly older (64.9 vs 49.3, P<0.001), older at nilotinib initiation (60.8 vs 46.5, P<0.001), with more arterial hypertension (40% vs 12.2%, P=0.01), with more cardiovascular risk factors (P=0.03). In patient with no cardiovascular risk factor 12.5% had VAA (n=24).
Nilotinib seems to be associated to arterial lesions of unstable lipid-like appearance. The most involved arterial territory was the carotid bulb and the most common lesion was echolucent or hypoechogenic plaque. VAA can occur in patients without cardiovascular risk factors. This result encourages us to systematically screen and follow all patients exposed to nilotinib even those without cardiovascular risk factors.
接受尼洛替尼治疗慢性髓性白血病（CML）的患者似乎存在动脉并发症的风险。超声无症状性动脉病变的发生率和表现尚不清楚。
描述接受尼洛替尼治疗的 CML 患者的超声动脉异常的发生率和特征。
回顾性纳入 2006 年至 2015 年在马赛的保罗-卡尔梅特研究所接受尼洛替尼治疗的患者。2010 年进行了血管超声筛查。描述首次检查时的动脉病变：斑块及其回声、狭窄或闭塞。存在临床和/或超声异常定义为血管动脉异常（VAA）。使用双变量和多变量分析比较初始血管检查时有无 VAA 的患者。
共纳入 74 例患者（51.4%为男性，平均年龄 54.5 岁）；25 例患者存在超声动脉异常（33.8%）。颈动脉球部是最常受累的部位（44%）。动脉异常包括：88%的斑块、44%>50%的狭窄和 12%的闭塞。72.7%的斑块为低回声或等回声。在初始血管评估时有 VAA 的 25 例患者（33.8%）。基线时有 VAA 的患者年龄明显较大（64.9 岁 vs 49.3 岁，P<0.001），尼洛替尼起始时年龄较大（60.8 岁 vs 46.5 岁，P<0.001），动脉高血压更多（40% vs 12.2%，P=0.01），心血管危险因素更多（P=0.03）。无心血管危险因素的患者中，有 12.5%（n=24）有 VAA。
尼洛替尼似乎与不稳定的脂质样外观的动脉病变有关。最常受累的动脉部位是颈动脉球部，最常见的病变是低回声或等回声斑块。无心血管危险因素的患者也可能发生 VAA。这一结果鼓励我们对所有接受尼洛替尼治疗的患者，即使是无心血管危险因素的患者，进行系统筛查和随访。
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