- 學位論文
頸動脈內膜中層厚度及斑塊進行之預測因子
Predictors of Carotid Intima-Media Thickness and Plaque Progression in a Chinese Population
摘要
背景及目的：動脈粥狀硬化造成的疾病在全球為一重要的死因。頸動脈內膜中層厚度（carotid intima-media thickness，IMT）及斑塊的增加已逐漸被當作動脈粥狀硬化進行的指標，可能能藉此預測未來產生心血管疾病的風險。現今較少研究探討亞洲族群頸動脈內膜中層厚度及斑塊進行的預測因子，故了解有限。本研究的主旨在於探討台灣族群頸動脈內膜中層厚度及斑塊增加的預測因子，並評估是否有性別差異之存在。 方法：本研究納入712名過去無心肌梗塞及腦中風的受試者，分別於收案時及平均追蹤4.3±0.9年後量測各段頸動脈內膜中層厚度及斑塊數目。多變項線性迴歸及邏輯式迴歸分析分別用於探討年齡、性別及心血管疾病危險因子對於頸動脈內膜中層厚度及斑塊進行的影響。也探討不同性別的差異性。 結果：對整體受試者而言，年齡及抽菸是總頸動脈（common carotid artery，CCA）內膜中層厚度增加的危險因子(調整後p= 6.84×10-5，0.045)，而年齡、高血壓及降血壓藥物的使用則是頸動脈分叉處（bifurcation，BIF）內膜中層增加厚度的預測因子(調整後p= 1.29×10-7，0.033，2.24×10-4)。針對有高血壓的受試者做分析，有使用降高血壓藥物相較於未使用者，各段頸動脈內膜中層厚度的進行較為緩慢，特別是在頸動脈分叉處。進一步性別分析發現，大多數的預測因子只存在於女性。而年齡及男性性別可預測斑塊的進行。 結論：此研究顯示，於台灣族群，頸動脈粥狀硬化進行在不同性別及不同段的頸動脈有不同的預測因子。發現及控制高血壓能阻止動脈粥狀硬化的進行，特別是在女性。
並列摘要
Background and Purpose Atherosclerotic diseases are the leading cause of death worldwide. Longitudinal changes in carotid intima-media thickness (IMT) and plaque are increasingly being used as markers of atherosclerosis progression and may predict future cardiovascular events. This study attempted to investigate the predictors of carotid IMT and plaque progression in a Chinese population, and to determine whether these predictors differ gender-wise. Methods Segmental-specific carotid IMT and plaque were measured in 712 stroke- and myocardial infarction-free subjects at baseline and after an average interval of 4.3±0.9 years. Multivariate linear regression and logistic regression were conducted to investigate the predictive effect of age, sex, and cardiovascular risk factors on carotid IMT and plaque progression. Sex-specific analyses were also explored. Results For overall subjects, age and smoking were predictors of common carotid artery (CCA) IMT progression (adjusted p=6.84×10-5and 0.045). Age, hypertension, and use of antihypertensive medication were predictors of bifurcation (BIF) IMT progression (adjusted p= 1.29×10-7, 0.033, 2.24×10-4 respectively). In hypertensive subjects, use of antihypertensive medication was associated with less annual IMT progression than without drugs control in all carotid artery segments, especially in the BIF. Further sex-stratified analysis showed that the predictors for IMT progression were mostly existed in women. As for plaque progression, age and sex were the independent predictors. Conclusions The present study indicates that predictors for carotid atherosclerosis progression are sex- and segmental specific. Detection and control of hypertension could preclude atherosclerosis progression, particularly in women.