颈动脉斑块和低踝臂指数联合作用增加老年人缺血性心脑血管事件的发生风险  

Increased risk of cardiovascular disease in elderly population with carotid plaque and low ankle brachial index

作　　者：李雯[1] 陈朔华 赵剑秋 沈铁柱 李晓庆[4] 蒋益民[1] 吴寿岭 Li Wen;Chen Shuohua;Zhao Jianqiu;Shen Tiezhu;Li Xiaoqing;Jiang Yimin;Wu Shouling(Department of Ultrasound,Shanghai Sixth People′s Hospital,Shanghai 200030,China;Kailuan Employee Security Center,Kailuan 063000,China;Department of Anesthesia,Shanghai Jiading District Hospital,Shanghai 201805,China;Department of Ultrasound,Kailuan General Hospital,Kailuan 063000,China)

机构地区：[1]上海市第六人民医院超声科,200030 [2]开滦员工保障中心,063000 [3]上海市嘉定区安亭医院麻醉科,201805 [4]开滦总医院超声科,063000

出　　处：《中华心血管病杂志》2021年第3期263-268,共6页Chinese Journal of Cardiology

基　　金：上海健康医学院种子基金 (HMSF-17-22-028)。

摘　　要：目的探讨颈动脉斑块和低踝臂指数(ABI)联合作用对老年人群缺血性心脑血管事件发生风险的影响。方法该研究为前瞻性队列研究。纳入2010至2011年度完成颈动脉超声和ABI检测的开滦研究老年队列中的人群。按照有无颈动脉斑块及有无ABI降低将入选者分为3组,即无颈动脉斑块且ABI>0.9组、有颈动脉斑块但ABI>0.9组和有颈动脉斑块且ABI≤0.9组。收集入选者的一般临床资料。对入选者进行随访并记录其缺血性心脑血管事件(包括心肌梗死和脑梗死)的发生情况,末次随诊时间为2016年12月31日。比较3组老年人群随访过程中缺血性心脑血管事件的发生情况。采用多因素Cox比例风险模型分析颈动脉斑块和低ABI对老年人群缺血性心脑血管事件发生风险的影响。结果共1642人入选该研究,年龄(67.1±6.4)岁,男性1028人(62.6%),其中无颈动脉斑块且ABI>0.9组526人、有颈动脉斑块但ABI>0.9组1067人、有颈动脉斑块且ABI≤0.9组49人。研究人群平均随访5.41年,无颈动脉斑块且ABI>0.9组、有颈动脉斑块但ABI>0.9组和有颈动脉斑块且ABI≤0.9组老年人群缺血性心脑血管事件发生率分别为2.1%(11/526)、5.5%(59/1067)和12.2%(6/49),差异有统计学意义(P<0.01);无颈动脉斑块且ABI>0.9组、有颈动脉斑块但ABI>0.9组和有颈动脉斑块且ABI≤0.9组老年人群心肌梗死发生率分别为0.2%(1/526)、1.6%(17/1067)和10.2%(5/49),差异有统计学意义(P<0.01),脑梗死发生率分别为1.9%(10/526)、3.9%(42/1067)和2.0%(1/49),差异无统计学意义(P>0.05)。校正了性别、年龄、收缩压、空腹血糖、体重指数、总胆固醇、吸烟、饮酒以及服用降压和调脂药物的情况后,多因素Cox比例风险模型分析结果显示有颈动脉斑块但ABI>0.9组和有颈动脉斑块且ABI≤0.9组老年人群发生缺血性心脑血管事件的风险均明显高于无颈动脉斑块且ABI>0.9组(分别为HR=3.52,95%CI 1.49~8.35,P=0.004;HR=7.16,Objective To investigate whether the co-presence of carotid plaques and low ankle-brachial index(ABI)might increase the risks of ischemic cardiovascular and cerebrovascular event in elderly population.Methods It was a prospective study.Participants from the elderly cohort of the Kailuan Study,who completed a carotid sonography and ABI examination,were included in this study.Participants underwent physical examinations between 2010 and 2011 and were divided into 3 groups:no carotid plaque and ABI>0.9 group(n=526),carotid plaque and ABI>0.9 group(n=1067),and carotid plaques and ABI≤0.9 group(n=49).Follow up ended on the 31 December 2016.The incidence of ischemic cardiovascular and cerebrovascular event was compared between the 3 groups,the relationship between carotid plaque and low ABI with ischemic cardiovascular and cerebrovascular event was analyzed.Results A total of 1642 participants were included(age,(67.1±6.4)years).There were 1028 males(62.6%)and 1028 females(37.4%).The average follow-up time was 5.41 years,the incidence of ischemic cardiovascular and cerebrovascular event in the 3 group was 2.1%(11/526),5.5%(59/1067),and 12.2%(6/49),respectively;the incidence of myocardial infarction in the 3 group was 0.2%(1/526),1.6%(17/1067),10.2%(5/49),respectively;the incidence of cerebral infarction in the 3 group was 1.9%(10/526),3.9%(42/1067)and 2.0%(1/49),respectively.Multivariate Cox risk proportional regression analysis showed that compared with the group without carotid plaque and ABI>0.9,the HR values(95%CI)of ischemic cardiovascular and cerebrovascular event in the group with carotid plaque and ABI>0.9,carotid plaques and ABI≤0.9 group were 3.52(1.49-8.35),7.16(2.11-24.26)respectively,after adjusting for sex,age,systolic blood pressure,fast blood glucose,body mass index,total cholesterol,smoke,alcohol consumption and lipid-lowering medication and antihypertensive medication.Conclusions Co-presence of carotid plaques and low ankle-brachial index may further increase the risk of ischemic cardiovascular an

关 键 词：心血管疾病 动脉粥样硬化 踝臂指数 

分 类 号：R543[医药卫生—心血管疾病] R743[医药卫生—内科学]