颈动脉斑块厚度可预测慢性肾脏病患者的心血管事件和死亡。
Carotid plaque thickness predicts cardiovascular events and death in patients with chronic kidney disease.
机构信息
Department of Nephrology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, DK-2100, Denmark.
Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, DK-2200, Denmark.
出版信息
BMC Nephrol. 2024 Oct 31;25(1):389. doi: 10.1186/s12882-024-03831-4.
BACKGROUND
Classical risk scoring systems underestimate the risk of cardiovascular disease in chronic kidney disease (CKD). Coronary artery calcium score (CACS) has improved prediction of cardiovascular events in patients with CKD. The maximal carotid plaque thickness (cPTmax) measured in ultrasound scans of the carotid arteries has demonstrated similar predictive value as CACS in the general population. This is the first study to investigate whether cPTmax can predict cardiovascular events in CKD and to compare the predictive value of cPTmax and CACS in CKD.
METHOD
Two hundred patients with CKD stage 3 from the Copenhagen CKD Cohort underwent ultrasound scanning of the carotid arteries. The assessment consisted of locating plaque and measuring the thickest part of the plaque, cPTmax. Based on the distribution of cPTmax, the participants were divided into 3 groups: No plaques, cPTmax 1.0-1.9 mm and cPTmax > 1.9 mm (median cPTmax = 1.9 mm among patients with plaques). To measure CACS, 175 of the patients underwent a non-contrast CT scan of the coronary arteries. The follow-up time spanned between the ultrasound scan and a predefined end-date or the time of first event, defined as a composite of major cardiovascular events or death of any cause (MACE).
RESULTS
The median follow-up time was 5.4 years during which 45 patients (22.5%) developed MACE. In a Cox-regression adjusted for classical cardiovascular risk factors, patients with cPTmax > 1.9 mm had a significantly increased hazard ratio of MACE (HR 3.2, CI: 1.1-9.3), p = 0.031) compared to patients without plaques. C-statistics was used to evaluate models for predicting MACE. The improvement in C-statistics was similar for the two models including classical cardiovascular risk factors plus cPTmax (0.247, CI: 0.181-0.312) and CACS (0.243, CI: 0.172-0.315), respectively, when compared to a model only controlled for time since baseline (a Cox model with no covariates).
CONCLUSION
Our results indicate that cPTmax may be useful for predicting MACE in CKD. cPTmax and CACS showed similar ability to predict MACE.
背景
经典风险评分系统低估了慢性肾脏病（CKD）患者发生心血管疾病的风险。冠状动脉钙评分（CACS）提高了 CKD 患者心血管事件的预测能力。颈动脉斑块厚度最大值（cPTmax）在颈动脉超声检查中的测量结果与一般人群中的 CACS 具有相似的预测价值。这是第一项研究，旨在探讨 cPTmax 是否可以预测 CKD 患者的心血管事件，并比较 CKD 患者中 cPTmax 和 CACS 的预测价值。
方法
来自哥本哈根 CKD 队列的 200 名 CKD 3 期患者接受了颈动脉超声检查。评估包括定位斑块和测量斑块最厚部分 cPTmax。根据 cPTmax 的分布，将参与者分为 3 组：无斑块、cPTmax 为 1.0-1.9mm 和 cPTmax>1.9mm（有斑块患者的中位数 cPTmax 为 1.9mm）。为了测量 CACS，175 名患者接受了冠状动脉非对比 CT 扫描。随访时间从超声扫描到预定截止日期或首次发生事件的时间，定义为主要心血管事件或任何原因死亡的复合终点（MACE）。
结果
中位随访时间为 5.4 年，45 名患者（22.5%）发生了 MACE。在调整了经典心血管危险因素的 Cox 回归中，cPTmax>1.9mm 的患者发生 MACE 的危险比显著增加（HR 3.2，CI：1.1-9.3），p=0.031）与无斑块的患者相比。使用 C 统计量评估用于预测 MACE 的模型。与仅控制基线后时间的模型（无协变量的 Cox 模型）相比，纳入经典心血管危险因素和 cPTmax 的两个模型（分别为 0.247，CI：0.181-0.312 和 0.243，CI：0.172-0.315）的 C 统计量的改善情况相似。
结论
我们的结果表明，cPTmax 可用于预测 CKD 患者的 MACE。cPTmax 和 CACS 具有相似的预测 MACE 的能力。
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