Holaj R, Spácil J, Petrásek J, Malík J, Aschermann M, Haas T
III. Interní klinika, LF UK a VFN, Praha.
Cas Lek Cesk. 1998 Nov 30;137(23):716-20.
Concomitant occurrence of carotid atherosclerosis, coronary artery disease (CAD) and peripheral vascular disease (PVD) has been described in a number of studies. The objective of the present trial was to assess the degree of correlation between atherosclerosis of the carotid beds as well as PVD and the extent of CAD.
Carotid morphologies of 170 patients in total (121 men, 49 women), ranging between 23 and 81 years in age were assessed ultrasonographically. Their carotid beds searched for plaques, stenoses and occlusions. In all patients intima-media thickness (IMT) of the common carotid artery (CCA) were measured ultrasonographically. In addition, case histories of PVD were taken. CAD was proved angiographically in 138 patients. Plaques in carotid beds were found in 98 patients, carotid artery stenoses > 75% were found in 4 patients whereas complete carotid occlusion was not detected in any patient. Clinically manifested PVD was found in 20 patients. A significant difference in IMT of the CCA was assessed by t-test between patients having and not having CAD (0.67 +/- 0.16 mm vs. 0.87 +/- 0.24 mm; P < 0.0001). The correlation between the IMT of the CCA and extent of CAD was weak (r = 0.30, p < 0.01). A positive correlation between carotid plaque occurrence and the number of CAD-affected arteries was statistically assessed (Trend test: P = 0.0001). The sensitivity of incidence of plaques on the carotid beds for prediction of CAD was 64%, the specificity 72%, the positive predictive value 91% and the negative predictive value 32%. The sensitivity of clinically manifested PVD for prediction of CAD was 15%, the specificity 100%, the positive predictive value 100% and the negative predictive value 21%.
The authors confirmed a statistically significant but weak correlation between IMT of the CCA and severity of CAD. They found a positive trend between the occurrence of carotid plaques and the number of CAD-affected arteries. The presence of carotid plaques and clinically manifested PVD were confirmed as a reliable positive predictive factors for CAD.
多项研究已描述了颈动脉粥样硬化、冠状动脉疾病（CAD）和外周血管疾病（PVD）的同时发生情况。本试验的目的是评估颈动脉床的动脉粥样硬化以及PVD与CAD程度之间的相关程度。
对总共170例患者（121例男性，49例女性）的颈动脉形态进行了超声检查评估，患者年龄在23至81岁之间。检查他们的颈动脉床是否存在斑块、狭窄和闭塞情况。对所有患者的颈总动脉（CCA）的内膜中层厚度（IMT）进行了超声测量。此外，还记录了PVD的病史。138例患者经血管造影证实患有CAD。98例患者的颈动脉床发现有斑块，4例患者的颈动脉狭窄>75%，而未发现任何患者有颈动脉完全闭塞情况。20例患者有临床表现的PVD。通过t检验评估，患有和未患有CAD的患者之间CCA的IMT存在显著差异（0.67±0.16毫米对0.87±0.24毫米；P<0.0001）。CCA的IMT与CAD程度之间的相关性较弱（r=0.30，p<0.01）。经统计学评估，颈动脉斑块的出现与CAD受累动脉数量之间存在正相关（趋势检验：P=0.0001）。颈动脉床斑块发生率对CAD预测的敏感性为64%，特异性为72%，阳性预测值为91%，阴性预测值为32%。临床表现的PVD对CAD预测的敏感性为15%，特异性为100%，阳性预测值为100%，阴性预测值为21%。
作者证实了CCA的IMT与CAD严重程度之间存在统计学上显著但较弱的相关性。他们发现颈动脉斑块的出现与CAD受累动脉数量之间存在正相关趋势。颈动脉斑块的存在和临床表现的PVD被确认为CAD可靠的阳性预测因素。
