Tkác I, Silver F, Lamarche B, Lewis G F, Steiner G
Department of Medicine, WHO Collaborating Centre for Study of Atherosclerosis in Diabetes, Toronto Hospital, University of Toronto, Ontario, Canada.
J Cardiovasc Risk. 1998 Apr;5(2):79-83.
Serum creatinine level has been reported to be related to the incidence of strokes.
To examine the relationship between serum creatinine level and the severity of extracranial carotid artery atherosclerosis.
This is a secondary analysis of data from 88 patients (59 men and 29 women) who had previously had transient ischaemic attacks or minor strokes and had been included in intervention trials of symptomatic carotid disease. Narrowing of internal carotid artery was estimated by angiography. Both internal carotid arteries were measured and the severity was expressed as the sum of percentage stenoses on both sides. The risk profiles of patients with moderate and severe internal carotid artery stenosis were compared.
The sex-adjusted mean serum creatinine concentration in those with severe carotid disease was significantly higher than that in those with moderate disease (106.3 +/- 3.3 versus 91.3 +/- 3.7 mumol/l, P = 0.003), but still within the normal range. The risk of having severe disease was compared with risk of having moderate disease for people ranked by their serum creatinine levels. Univariate logistic regression showed that the odds ratio (OR) for having severe involvement of internal carotid artery was greater for patients in mid-tertile of creatinine values than it was for those in the lowest tertile (OR 6.3, 95% confidence interval 2.0-20.4, P = 0.002). The creatinine levels of patients in these two tertiles were within the normal range. The OR was no greater for patients in the highest tertile of creatinine values, which were slightly elevated above the normal range. These OR did not change after adjustment for age, sex, hypertension or systolic blood pressure, diabetes, smoking and lipid levels.
Results of this study demonstrate for the first time that serum creatinine level, even within the range of upper normal or mildly elevated levels, is related to the angiographic severity of internal carotid artery disease in patients who have previously had transient ischaemic attacks and that this relationship is independent of classic cardiovascular risk factors.
据报道，血清肌酐水平与中风发病率有关。
研究血清肌酐水平与颅外颈动脉粥样硬化严重程度之间的关系。
这是一项对88例患者（59例男性和29例女性）数据的二次分析，这些患者既往有短暂性脑缺血发作或轻度中风，且已纳入有症状颈动脉疾病的干预试验。通过血管造影术评估颈内动脉狭窄情况。测量双侧颈内动脉，严重程度以双侧狭窄百分比之和表示。比较中度和重度颈内动脉狭窄患者的风险特征。
重度颈动脉疾病患者经性别调整后的平均血清肌酐浓度显著高于中度疾病患者（106.3±3.3对91.3±3.7μmol/L，P = 0.003），但仍在正常范围内。根据血清肌酐水平对患者进行排序，比较重度疾病风险与中度疾病风险。单因素逻辑回归显示，肌酐值处于中间三分位数的患者，其颈内动脉严重受累的比值比（OR）高于最低三分位数的患者（OR 6.3，95%置信区间2.0 - 20.4，P = 0.002）。这两个三分位数患者的肌酐水平均在正常范围内。肌酐值处于最高三分位数（略高于正常范围）的患者，其OR并无更高。在对年龄、性别、高血压或收缩压、糖尿病、吸烟和血脂水平进行调整后，这些OR没有变化。
本研究结果首次表明，即使血清肌酐水平处于正常上限或轻度升高范围内，对于既往有短暂性脑缺血发作的患者，其与颈内动脉疾病的血管造影严重程度相关，且这种关系独立于经典心血管危险因素。
