Atherosclerotic plaques occur in absence of intima-media thickening in both systemic sclerosis and systemic lupus erythematosus: a duplexsonography study of carotid and femoral arteries and follow-up for cardiovascular events
Atherosclerotic plaques occur in absence of intima-media thickening in both systemic sclerosis and systemic lupus erythematosus: a duplexsonography study of carotid and femoral arteries and follow-up for cardiovascular events
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DOI：
10.1186/ar4489
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发表时间：
2014-01-01
影响因子：
4.9
通讯作者：
Weiner, Stefan Markus
中科院分区：
文献类型：
--
作者：
Frerix, Marc;Stegbauer, Johannes;Weiner, Stefan Markus
简介：这项横断面回顾性队列研究的目的是：（1）确定内膜中层厚度（IMT）与斑块评估相比的有用性;（2）检查附加股动脉超声检查的价值;（3）确定系统性硬化症（SSc）和系统性红斑狼疮（SLE）患者动脉粥样硬化和心血管事件的潜在危险因素。本文对90例SSc和100例SLE患者进行了超声检查。测量颈总动脉和股总动脉的IMT，评估颈总动脉、颈内动脉、颈外动脉和股总动脉、近端浅动脉和深动脉的斑块。比较不同定义的病理性IMT（pIMT）与斑块的存在。结果与基线动脉粥样硬化的传统和非传统危险因素相关（逻辑回归）及其对随访期间心血管事件的预测价值结果：在这两种疾病中，明确的动脉粥样硬化经常发生，而没有亚临床动脉粥样硬化的迹象：pIMT >0.9 mm仅见于17/59（28.9%）SSc和13/49（26.5%）SLE患者，这些患者已经存在动脉粥样硬化斑块。使用年龄校正的pIMT定义，该比率甚至更低（SSc为5.1-10.3%，SLE为14.3-26.5%）。斑块仅位于颈动脉或仅位于股动脉分别为26例（13.7%）和24例（12.6%）。年龄和尼古丁包年与SLE和SSc患者的动脉粥样硬化斑块独立相关，SSc亚组中的累积泼尼松龙剂量也是如此，ssDNA阳性的SLE患者发生动脉粥样硬化斑块的风险较低。随访期间（129/190（67.9%）例患者，650人-年），冠心病患者更常发生心血管事件（调整风险比（HR）10.19，95%置信区间（CI）3.04至34.17，P < 0.001），男性患者（调整后HR 8.78，95%CI 2.73 ~ 28.19，P < 0.001）和颈动脉和股动脉斑块共存患者（调整后HR 5.92，95%CI 1.55 ~ 22.67，P = 0.009）。单纯颈动脉或股动脉斑块的患者并不处于较高的risk.Conclusion：动脉粥样硬化斑块病变，可以发现在SSc和SLE患者的内膜中层增厚的情况下频繁。除了常规的颈动脉超声检查外，还建议进行股动脉超声检查，以识别其他动脉粥样硬化病变，并检测心血管事件高风险患者。
Introduction: The objective of this cross-sectional and retrospective cohort study was (1) to determine the usefulness of intima-media thickness (IMT) in contrast to plaque assessment, (2) to examine the value of additive femoral artery sonography and (3) to identify potential risk factors for atherosclerosis and incident cardiovascular events in systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) patients.Methods: In this study, 90 SSc and 100 SLE patients were examined by duplexsonography. IMT was measured in common carotid and common femoral arteries, plaques were assessed in common, internal and external carotid and common, proximal superficial and deep femoral arteries. Different definitions of pathological IMT (pIMT) were compared with the presence of plaque. Results were evaluated in relation to traditional and non-traditional risk factors for baseline atherosclerosis (logistic regression) and their predictive value for cardiovascular events during follow-up (cox regression).Results: Definite atherosclerosis occurred frequently without signs of subclinical atherosclerosis in both diseases: pIMT >0.9 mm was present in only 17/59 (28.9%) SSc and 13/49 (26.5%) SLE patients with already present atherosclerotic plaques. Using age-adjusted pIMT definitions, this rate was even lower (5.1-10.3% in SSc, 14.3-26.5% in SLE). Plaques were located only at the carotid or only at the femoral arteries in 26 (13.7%) and 24 (12.6%) patients, respectively. Age and nicotine pack-years were independently associated with atherosclerotic plaques in SLE and SSc patients, as well as the cumulative prednisolone dose in SSc subgroup, and ssDNA positive SLE patients had a lower risk for atherosclerotic plaque. During follow-up (available for 129/190 (67.9%) patients, 650 person-years), cardiovascular events occurred more often in patients with coronary heart disease (adjusted-hazards ratio (HR) 10.19, 95% confidence interval (CI) 3.04 to 34.17, P < 0.001), male patients (adjusted-HR 8.78, 95% CI 2.73 to 28.19, P < 0.001) and in patients with coexistent carotid and femoral plaques (adjusted-HR 5.92, 95% CI 1.55 to 22.67, P = 0.009). Patients with solely carotid or femoral plaque were not at higher risk.Conclusion: Atherosclerotic plaque lesions can be found frequently in absence of intima-media thickening in both SSc and SLE patients. As well as routine sonography of carotid arteries, the sonography of femoral arteries is recommended to identify additional atherosclerotic lesions and to detect patients at a high risk for cardiovascular events.