Park Huiyul, Jun Dae Won, Park Hoon-Ki, Park Kye-Yeung, Hwang Hwan-Sik
Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
Ann Transl Med. 2021 Apr;9(7):566. doi: 10.21037/atm-20-7219.
Although carotid artery sonography is widely performed, most guidelines do not recommend this procedure in the general population. Appropriate indications and effective algorithms are needed to detect advanced carotid artery atherosclerosis in a community setting.
This study was designed as cross-sectional study. Adult subjects (n=228) who underwent a health check-up at our healthcare centre were included in the final analysis. Mac-2 binding protein glycosylation isomer (M2BPGi) quantification was based on a lectin antibody sandwich immunoassay. Subclinical atherosclerosis was diagnosed by carotid ultrasonography.
The prevalence of subclinical atherosclerosis and advanced atherosclerosis was 37.2% (85/228) and 11.8% (27/228), respectively, in a community-based setting. Serum M2BPGi level was significantly higher in subjects with calcified plaque (0.6317) and luminal stenosis (0.6373) than in control groups (0.4913, all P<0.05). Pearson correlation analysis between M2BPGi and atherosclerotic cardiovascular disease (ASCVD) risk index (R=0.410, P<0.001) showed a positive relationship. The AUROC of serum M2BPGi for identifying calcified plaque or luminal stenosis was 0.679. The sequential algorithm using ASCVD and M2BPGi showed good negative predictive value (NPV) (93.6%) and reasonable positive predictive value (PPV) (53.8%) for identifying calcified plaque or luminal stenosis. When the sequential algorithm was used as an indicator for carotid ultrasonography, 35.0% (14/40) of subjects with intermediate-risk by ASCVD (≥7.5%) could avoid unnecessary carotid ultrasonography.
The sequential algorithm using ASCVD (≥7.5) and M2BPGi (≥0.525) provided reasonable indication for carotid artery sonography in a community-based setting.
尽管颈动脉超声检查应用广泛，但大多数指南并不推荐在普通人群中进行此项检查。在社区环境中，需要合适的适应证和有效的算法来检测晚期颈动脉粥样硬化。
本研究设计为横断面研究。最终分析纳入了在我们医疗中心接受健康检查的成年受试者（n = 228）。巨噬细胞2型清道夫受体结合蛋白糖基化异构体（M2BPGi）定量基于凝集素抗体夹心免疫测定法。亚临床动脉粥样硬化通过颈动脉超声诊断。
在社区环境中，亚临床动脉粥样硬化和晚期动脉粥样硬化的患病率分别为37.2%（85/228）和11.8%（27/228）。有钙化斑块（0.6317）和管腔狭窄（0.6373）的受试者血清M2BPGi水平显著高于对照组（0.4913，均P<0.05）。M2BPGi与动脉粥样硬化性心血管疾病（ASCVD）风险指数之间的Pearson相关分析（R = 0.410，P<0.001）显示呈正相关。血清M2BPGi用于识别钙化斑块或管腔狭窄的曲线下面积（AUROC）为0.679。使用ASCVD和M2BPGi的序贯算法在识别钙化斑块或管腔狭窄方面显示出良好的阴性预测值（NPV）（93.6%）和合理 的阳性预测值（PPV）（53.8%）。当序贯算法用作颈动脉超声检查的指标时，35.0%（14/40）ASCVD中风险（≥7.5%）的受试者可避免不必要的颈动脉超声检查。
使用ASCVD（≥7.5）和M2BPGi（≥0.525）的序贯算法为社区环境中的颈动脉超声检查提供了合理的适应证。
