颈动脉最大斑块面积的进展速率与新发缺血性心血管事件的关系

摘要

Objective: To explore the progression rate of cortid maximal plaque area and the risk of new ischemic cardiovascular disease (ICVD) in a rural cohort in Beijing. Methods: The PRC-USA collaborative study had been regularly conducted in Shijingshan area in Beijing. The carotid ultrasound examination, ICVD risk factor and acute cardiovascular events follow-up were conducted in those participants. A total of 1479 subjects who received at least 2 carotid ultrasound examinations and had no cardiovascular disease before the second ultrasound were studied. They were divided into 5 groups:①Control group, the participants had no plaque detected by 2 ultrasounds; ② New plaque group, new plaque was found at the second ultrasound examination; ③ Plaque regression group; ④ Plaque stabilized group and ⑤ Plaque progression group. The hazard ratio (HR) between the progression rate of corotid maximal plaque area and new ICVD events was estimated by Cox proportional hazard regression analysis . Results: Compared with Control group, the HR for new ICVD events were higher in groups②,③,④and⑤at 3.5, 5.7, 6.2 and 7.3 respectively, all P<0.05. The increasing trend of HRs remained signiifcant with the adjusted age and gender, P<0.001. Conclusion: The progression rate of maximal corot id plaque area rate could predict the risk of new ICVD events in clinical practice.%目的：探讨最大斑块面积进展速率与新发缺血性心血管事件的关系。　　方法：对“中美心血管病和心肺疾病流行病学合作研究”中的石景山人群进行定期颈动脉超声检查、心血管危险因素调查和急性心血管事件的随访。至少接受过两次超声检查且第二次检查前没有发生过心血管事件的1479名研究对象被纳入分析。研究对象按照基线有无斑块等分为5组即对照组（两次检查均无斑块检出）、新发斑块组、斑块逆转组、斑块稳定组和斑块进展组。用Cox比例风险模型估计两次检查间颈动脉最大斑块面积进展速率与第二次检查后新发缺血性心血管事件的比例风险（HR）。　　结果：无论是单因素分析还是调整年龄和性别后，当以基线和复查均无斑块即对照组作为参考时，新发斑块组、斑块逆转组、斑块稳定组、斑块进展组发生缺血性心血管事件的风险均显著地高于对照组，风险比依次为3.5，5.7，6.2和7.3；P值均<0.05。风险比逐渐趋势在调整年龄和性别后仍然具有统计学显著性（趋势检验P<0.001）。　　结论：最大斑块面积进展速率可预测缺血性心血管事件的风险，该结果支持斑块面积指标作为风险评估和疗效评价的工具用于临床实践。