Li Zhui, Yang Hong, Zhang Wenfang, Wang Jing, Zhao Yu, Cheng Jun
Department of Vascular Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Departments of Ultrasound, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
BMJ Open. 2021 Apr 30;11(4):e042926. doi: 10.1136/bmjopen-2020-042926.
This study aimed to investigate the prevalence and identify predictive factors of asymptomatic carotid artery stenosis (ACAS) in Southern Chinese patients with peripheral arterial disease (PAD).
A cross-sectional study.
A total of 653 patients with PAD admitted to the First Affiliated Hospital of Chongqing Medical University from July 2014 to July 2019.
The degree of carotid stenosis was assessed by Duplex ultrasound and classified as normal (no stenosis), mild (<50% stenosis), moderate (50%-69% stenosis), severe (≥70% stenosis or near occlusion) and total occlusion. Patients with stenosis ≥50% were classified as having significant ACAS. Multivariable logistic regression analysis was used to calculate the risk associated with concomitant factors of ACAS.
The mean age was 71.5±5.5 years, and 55.9% of the patients were men. Significant ACAS stenosis accounted for 128 (19.6%) cases, including 68 (10.4%) cases of moderate stenosis (50%-69%), 46 (7.0%) cases of severe stenosis (70%-99%) and 14 (2.1%) cases of total occlusion. Multivariable analysis revealed that age ≥70 years (OR 2.0, 95% CI 1.25 to 3.18), an ankle brachial index (ABI) ≤0.5 (OR 3.39, 95% CI 1.34 to 8.55), an ABI ≤0.4 (OR 3.86, 95% CI 1.47 to 10.06) and Fontaine stage IV (OR 4.53, 95% CI 1.47 to 13.88) are predictive factors of significant ACAS.
The prevalence of significant ACAS (stenosis ≥50%) in patients with PAD was approximately 19.6%. Significant ACAS was more common in patients with PAD older than 70 years, particularly in patients with an ABI <0.5 and those classified as Fontaine stage IV. Selective carotid screening may be more worthwhile in these high-risk patients with PAD.
本研究旨在调查中国南方外周动脉疾病（PAD）患者无症状性颈动脉狭窄（ACAS）的患病率，并确定其预测因素。
一项横断面研究。
2014年7月至2019年7月期间，重庆医科大学附属第一医院收治的653例PAD患者。
采用双功超声评估颈动脉狭窄程度，分为正常（无狭窄）、轻度（狭窄<50%）、中度（狭窄50%-69%）、重度（狭窄≥70%或接近闭塞）和完全闭塞。狭窄≥50%的患者被分类为患有显著ACAS。采用多变量逻辑回归分析计算与ACAS伴随因素相关的风险。
平均年龄为71.5±5.5岁，55.9%的患者为男性。显著ACAS狭窄占128例（19.6%），其中中度狭窄（50%-69%）68例（10.4%），重度狭窄（70%-99%）46例（7.0%），完全闭塞14例（2.1%）。多变量分析显示，年龄≥70岁（比值比2.0，95%置信区间1.25至3.18）、踝臂指数（ABI）≤0.5（比值比3.39，95%置信区间1.34至8.55）、ABI≤0.4（比值比3.86，95%置信区间1.47至10.06）和Fontaine IV期（比值比4.53，95%置信区间1.47至13.88）是显著ACAS的预测因素。
PAD患者中显著ACAS（狭窄≥50%）的患病率约为19.6%。显著ACAS在70岁以上的PAD患者中更为常见，尤其是ABI<0.5的患者和被分类为Fontaine IV期的患者。在这些高危PAD患者中进行选择性颈动脉筛查可能更有价值。
