Adams M R, Nakagomi A, Keech A, Robinson J, McCredie R, Bailey B P, Freedman S B, Celermajer D S
Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
Circulation. 1995 Oct 15;92(8):2127-34. doi: 10.1161/01.cir.92.8.2127.
Intima-media thickness (IMT) of the common carotid artery (CCA), measured with external vascular ultrasound, has been widely used in clinical trials as a surrogate marker for coronary atherosclerosis. Despite this, the degree of correlation between carotid IMT and the extent and severity of coronary artery disease (CAD) is not known.
Common carotid IMT was measured by ultrasound in 350 consecutive subjects of age 60 +/- 10 years (range, 30 to 85 years) on the day of coronary angiography. Carotid mean IMT was 0.83 +/- 0.20 mm (range, 0.43 to 1.80 mm), and maximum IMT was 1.04 +/- 0.27 mm (range, 0.49 to 2.19 mm). Coronary angiograms were analyzed by independent observers for disease severity (number of vessels with > or = 70% stenosis), extent score, and a modified Gensini score. Mean carotid IMT was weakly but significantly correlated with CAD severity (r = .26), extent (r = .23), and modified Gensini score (r = .29, P < .0001 for all correlations). Carotid IMT was not clinically useful, however, because it was not specific or sensitive enough to identify patients with or without significant CAD. Increasing age, male sex, and presence of diabetes were all associated with a significantly (P < .01) higher CAD score than the average for any level of carotid IMT, suggesting differential effects of these traditional risk factors on the coronary and common carotid arteries.
Although carotid IMT is significantly correlated with extent and severity of CAD, the relationship is weak. This relatively poor correlation (r2 < .10) should be considered in the interpretation of clinical trials that use carotid IMT as a surrogate end point for coronary atherosclerosis.
通过体外血管超声测量的颈总动脉（CCA）内膜中层厚度（IMT），已在临床试验中广泛用作冠状动脉粥样硬化的替代标志物。尽管如此，颈动脉IMT与冠状动脉疾病（CAD）的范围和严重程度之间的相关程度尚不清楚。
在冠状动脉造影当天，对350名年龄在60±10岁（范围为30至85岁）的连续受试者进行超声测量颈总动脉IMT。颈动脉平均IMT为0.83±0.20毫米（范围为0.43至1.80毫米），最大IMT为1.04±0.27毫米（范围为0.49至2.19毫米）。由独立观察者分析冠状动脉造影，以评估疾病严重程度（狭窄≥70%的血管数量）、范围评分和改良的Gensini评分。平均颈动脉IMT与CAD严重程度（r = 0.26）、范围（r = 0.23）和改良的Gensini评分（r = 0.29，所有相关性P < 0.0001）呈弱但显著的相关性。然而，颈动脉IMT在临床上并无用处，因为它不够特异或敏感，无法识别有无显著CAD的患者。年龄增加、男性和糖尿病的存在均与CAD评分显著（P < 0.01）高于任何颈动脉IMT水平的平均值相关，表明这些传统危险因素对冠状动脉和颈总动脉有不同影响。
虽然颈动脉IMT与CAD范围和严重程度显著相关，但这种关系较弱。在将颈动脉IMT用作冠状动脉粥样硬化替代终点的临床试验解释中，应考虑这种相对较差的相关性（r² < 0.10）。
