ハイリスク高齢者におけるアテローム血栓性脳梗塞およびラクナ梗塞と頸動脈超音波所見との関連 断面調査による検討
【目的】頸動脈超音波検査で得られる指標が脳梗塞の発症予測因子となる報告は多い. 今回我々は断面調査にて生活習慣病を有するハイリスク高齢者におけるアテローム血栓性脳梗塞およびラクナ梗塞と頸動脈超音波所見との関連性を検討した.【方法】対象は高血圧症, 糖尿病および高脂血症のいずれかで加療され頸動脈超音波検査を受けた65歳以上の男女314例である. 対照群, アテローム血栓性脳梗塞群およびラクナ梗塞群の3群に分類し背景因子 (生化学検査, Body Mass Index, 血圧, 喫煙歴, 高血圧症, 糖尿病, スタチン服用) および頸動脈超音波指標の内膜中膜複合体厚 (intima-media t...
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| Published in | 日本老年医学会雑誌 Vol. 42; no. 6; pp. 684 - 690 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本老年医学会
25.11.2005
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0300-9173 |
| DOI | 10.3143/geriatrics.42.684 |
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| Abstract | 【目的】頸動脈超音波検査で得られる指標が脳梗塞の発症予測因子となる報告は多い. 今回我々は断面調査にて生活習慣病を有するハイリスク高齢者におけるアテローム血栓性脳梗塞およびラクナ梗塞と頸動脈超音波所見との関連性を検討した.【方法】対象は高血圧症, 糖尿病および高脂血症のいずれかで加療され頸動脈超音波検査を受けた65歳以上の男女314例である. 対照群, アテローム血栓性脳梗塞群およびラクナ梗塞群の3群に分類し背景因子 (生化学検査, Body Mass Index, 血圧, 喫煙歴, 高血圧症, 糖尿病, スタチン服用) および頸動脈超音波指標の内膜中膜複合体厚 (intima-media thickness) 最大値 (Max-IMT), プラークスコア (PLQ-S), pulsatility index 最大値 (Max-PI) の差を検討した.【結果】アテローム血栓性脳梗塞の頸動脈超音波指標では対照群に比しPLQ-Sおよび Max-PI は有意に高値, PLQ-S 10mm以上および Max-PI 2.0以上の頻度は有意に高率であったが, Max-IMT は差が無かった. ラクナ梗塞群のこれらの指標はいずれも対照群と差が無かった. 多重ロジスティック回帰分析ではアテローム血栓性脳梗塞とPLQ-S 10mm以上 (オッズ比2.980; P=0.011) およびMax-PI 2.0以上 (オッズ比2.458; P=0.038) が有意な相関を示した. ラクナ梗塞とは有意の相関を認めた指標は無かった.【結論】ハイリスク高齢者の頸動脈超音波所見において, PLQ-SとPIはアテローム血栓性脳梗塞と有意の関連性を示した. しかし, IMTとアテローム血栓性脳梗塞およびこれらいずれの頸動脈超音波指標とラクナ梗塞との間には有意の関連性を認めなかった. |
|---|---|
| AbstractList | 【目的】頸動脈超音波検査で得られる指標が脳梗塞の発症予測因子となる報告は多い. 今回我々は断面調査にて生活習慣病を有するハイリスク高齢者におけるアテローム血栓性脳梗塞およびラクナ梗塞と頸動脈超音波所見との関連性を検討した.【方法】対象は高血圧症, 糖尿病および高脂血症のいずれかで加療され頸動脈超音波検査を受けた65歳以上の男女314例である. 対照群, アテローム血栓性脳梗塞群およびラクナ梗塞群の3群に分類し背景因子 (生化学検査, Body Mass Index, 血圧, 喫煙歴, 高血圧症, 糖尿病, スタチン服用) および頸動脈超音波指標の内膜中膜複合体厚 (intima-media thickness) 最大値 (Max-IMT), プラークスコア (PLQ-S), pulsatility index 最大値 (Max-PI) の差を検討した.【結果】アテローム血栓性脳梗塞の頸動脈超音波指標では対照群に比しPLQ-Sおよび Max-PI は有意に高値, PLQ-S 10mm以上および Max-PI 2.0以上の頻度は有意に高率であったが, Max-IMT は差が無かった. ラクナ梗塞群のこれらの指標はいずれも対照群と差が無かった. 多重ロジスティック回帰分析ではアテローム血栓性脳梗塞とPLQ-S 10mm以上 (オッズ比2.980; P=0.011) およびMax-PI 2.0以上 (オッズ比2.458; P=0.038) が有意な相関を示した. ラクナ梗塞とは有意の相関を認めた指標は無かった.【結論】ハイリスク高齢者の頸動脈超音波所見において, PLQ-SとPIはアテローム血栓性脳梗塞と有意の関連性を示した. しかし, IMTとアテローム血栓性脳梗塞およびこれらいずれの頸動脈超音波指標とラクナ梗塞との間には有意の関連性を認めなかった. |
| Author | 大庭, 建三 中野, 博司 渡邉, 健太郎 鈴木, 達也 |
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| References | 12) Whisnant JP: Special report from the National Institute of Neurological Disorders and Stroke; Classification of cerebrovascular diseases III. Stroke 1990; 21: 637-676. 20) O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK: Carotid-arterial intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med 1999; 340: 14-22. 31) Lovett JK, Howard SC, Rothwell PM: Pulse pressure is independently associated with carotid plaque ulceration. J Hypertens 2003; 21: 1669-1676. 19) Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE: Common carotid intima-media thickness and risk of stroke and myocardial infarction; the Rotterdam Study. Circulation 1997; 96: 1432-1437. 24) Spence JD: Ultrasound measurement of carotid plaque as a surrogate outcome for coronary artery disease. Am J Cardiol 2002; 89 (suppl): 10B-16B. 7) Touboul P-J, Elbaz A, Koller C, Lucas C, Adrai V, Chedru F, et al.: Common carotid artery intima-media thickness and brain infarction. Circulation 2000; 102: 313-318. 28) Okura T, Watanabe S, Miyoshi K, Fukuoka T, Higaki J: Intrarenal and carotid hemodynamics in patients with essential hypertension. Am J Hypertens 2004; 17: 240-244. 29) Frauchiger B, Schmid HP, Roedel C, Moosmann P, Staub D: Duplex sonographic registration of age and diabetes-related loss of renal vasodialatory response to nitroglycerine. Nephrol Dial Transplant 2000; 15: 827-832. 27) Frauchiger B, Bock A, Eichlisberger R, Landmann J, Thiel G, Mihatsch MJ, et al.: The value of different resistance parameters in distinguishing biopsy-proved dysfunction of renal allografts. Nephrol Dial Transplant 1995; 10: 527-532. 5) Nagai Y, Kitagawa K, Yamagami H, Kondo K, Hougaku H, Hori H, et al.: Carotid artery intima-media thickness and plaque score for the risk assessment of stroke subtypes. Ultrasound in Medicine and Biology 2002; 10: 1239-1243. 9) Nagai Y, Kitagawa K, Sakaguchi M, Shimizu Y, Hashimoto H, Yamagami H, et al.: Significance of earlier carotid atherosclerosis for stroke subtypes. Stroke 2001; 32: 1780-1785. 15) O'Leary DH, Polak JF, Wolfson SK Jr., Bond MG, Bommer W, Sheth S, et al. on behalf of the CHS Collaborative Research Group: Use of sonography to evaluate carotid atherosclerosis in the elderly, the Cardiovascular Health Study. Stroke 1991; 22: 1155-1163. 4) Handa N, Matsumoto M, Maeda H, Hougaku H, Kamada T, for the OSACA Study Group: Ischemic stroke events and carotid atherosclerosis, results of the Osaka Follow-up Study for ultrasonographic assessment of carotid atherosclerosis (the OSACA Study). Stroke 1995; 26: 1781-1786. 11) Nakatou T, Nakata K, Nakamura A, Itoshima T: Carotid haemodynamic parameters as risk factors for cerebral infarction in Type 2 diabetic patients. Diabet Med 2004; 21: 223-229. 16) Ishimura E, Nishizawa Y, Kawagishi T, Okuno Y, Kogawa K, Fukumoto S, et al.: Internal hemodynamic abnormalities in diabetic nephropathy measured by duplex Doppler sonography. Kidney Int 1997; 51: 1920-1927. 10) Hollander M, Bots ML, del Sol I, Koudstaal PJ, Witterman JCM, Grobbee DE, et al.: Carotid plaque increase the risk of stroke and subtypes of cerebral infarction in asymptomatic elderly; the Rotterdam Study. Circulation 2002; 105: 2872-2877. 13) Guidelines Subcommittee: 1999 World Health Organization-International Society of Hypertension guidelines for the management of hypertension. J Hypertens 1999; 17: 151-183. 18) Burke GL, Evans GW, Riley WA, Sharrett AR, Howard G, Barnes RW, et al. for the ARIC Study group: Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults; the Atherosclerosis Risk in Communities (ARIC) study. Stroke 1995; 26: 386-391. 14) The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997; 20: 1183-1197. 22) Mannami T, Baba S, Ogata J: Strong and significant relationship between aggregation of major coronary risk factors and the acceleration of carotid atherosclerosis in the general populaton of a Japanese city; the Suita Study. Arch Intern Med 2000; 160: 2297-2303. 1) 藤島正敏: 脳血管障害の最近の動向. 日本医師会雑誌2001; 125: S32-S37. 6) Nagai Y, Kitagawa K, Sakaguchi M, Shimizu Y, Hashimoto H, Yamagami H, et al.: Significance of early carotid atherosclerosis for stroke subtypes. Stroke 2001; 32: 1780-1785. 17) Kitamura A, Iso H, Imano H, Ohira T, Sato S, Naito Y, et al.: Prevalence and correlates of carotid atherosclerosis among elderly Japanese men. Atherosclerosis 2004; 172: 353-359. 26) Arboix A, Marti-Vilalta JL: New concepts in lacunar stroke etiology: the constellation of small-vessel arterial disease. Cerebrovas Dis 2004; 17 (suppl 1): 58-62. 2) Nagao T, Sadoshima S, Ibayashi S, Takeya Y, Fujishima M: Increase in extracranial atherosclerotic carotid lesions in patients with brain ischemia in Japan; An angiographic study. Stroke 1994; 25: 766-770. 3) 岩本俊彦: 頸動脈病変の臨床的意義. 日老医誌 2002; 39: 516-519. 8) Cupini LM, Pasqualetti P, Diomedi M, Vernieri F, Silvestrini M, Rizzato B, et al.: Carotid artery intima-media thickness and lacunar versus nonlacunar infarcts. Stroke 2002; 33: 689-694. 30) Simons PCG, Algra A, Bots ML, Grobbee D, van der Graaf Y, for the SMART Study Group: Commom carotid intima-media thickness and arterial stiffness: indicators of cardiovascular risk in high-risk patients: the SMART Study (Second Manifestations of ARTerial disease). Circulation 1999; 100: 951-957. 32) Dijk JM, van der Graaf Y, Grobbee DE, Bots ML, SMART Study Group: Carotid stiffness indicates risk of ischemic stroke and TIA in patients with internal carotid artery stenosis: The SMART Study. Stroke 2004; 35: 2258-2262. 21) Howard G, Sharrett AR, Heiss G, Evans GW, Chambless LE, Riley WA: Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-mode ultrasound. Stroke 1993; 24: 1297-1304. 25) Ebrahim S, Papacosta O, Whincup P, Wannamethee G, Walker M, Nicolaides AN, et al.: Carotid plaque, intima media thickness, cardiovascular risk factors, and prevalent cardiovascular disease in men and women. The British Regional Heart Study. Stroke 1999; 30: 841-850. 23) Spence JD, Eliasziw M, DiCicco M, Hackam DG, Galil R, Lohmann T: Carotid plaque area: a tool for targeting and elevating vascular prevention therapy. Stroke 2002; 33: 2916-2922. |
| References_xml | – reference: 7) Touboul P-J, Elbaz A, Koller C, Lucas C, Adrai V, Chedru F, et al.: Common carotid artery intima-media thickness and brain infarction. Circulation 2000; 102: 313-318. – reference: 6) Nagai Y, Kitagawa K, Sakaguchi M, Shimizu Y, Hashimoto H, Yamagami H, et al.: Significance of early carotid atherosclerosis for stroke subtypes. Stroke 2001; 32: 1780-1785. – reference: 32) Dijk JM, van der Graaf Y, Grobbee DE, Bots ML, SMART Study Group: Carotid stiffness indicates risk of ischemic stroke and TIA in patients with internal carotid artery stenosis: The SMART Study. Stroke 2004; 35: 2258-2262. – reference: 24) Spence JD: Ultrasound measurement of carotid plaque as a surrogate outcome for coronary artery disease. Am J Cardiol 2002; 89 (suppl): 10B-16B. – reference: 19) Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE: Common carotid intima-media thickness and risk of stroke and myocardial infarction; the Rotterdam Study. Circulation 1997; 96: 1432-1437. – reference: 8) Cupini LM, Pasqualetti P, Diomedi M, Vernieri F, Silvestrini M, Rizzato B, et al.: Carotid artery intima-media thickness and lacunar versus nonlacunar infarcts. Stroke 2002; 33: 689-694. – reference: 9) Nagai Y, Kitagawa K, Sakaguchi M, Shimizu Y, Hashimoto H, Yamagami H, et al.: Significance of earlier carotid atherosclerosis for stroke subtypes. Stroke 2001; 32: 1780-1785. – reference: 23) Spence JD, Eliasziw M, DiCicco M, Hackam DG, Galil R, Lohmann T: Carotid plaque area: a tool for targeting and elevating vascular prevention therapy. Stroke 2002; 33: 2916-2922. – reference: 31) Lovett JK, Howard SC, Rothwell PM: Pulse pressure is independently associated with carotid plaque ulceration. J Hypertens 2003; 21: 1669-1676. – reference: 1) 藤島正敏: 脳血管障害の最近の動向. 日本医師会雑誌2001; 125: S32-S37. – reference: 25) Ebrahim S, Papacosta O, Whincup P, Wannamethee G, Walker M, Nicolaides AN, et al.: Carotid plaque, intima media thickness, cardiovascular risk factors, and prevalent cardiovascular disease in men and women. The British Regional Heart Study. Stroke 1999; 30: 841-850. – reference: 29) Frauchiger B, Schmid HP, Roedel C, Moosmann P, Staub D: Duplex sonographic registration of age and diabetes-related loss of renal vasodialatory response to nitroglycerine. Nephrol Dial Transplant 2000; 15: 827-832. – reference: 16) Ishimura E, Nishizawa Y, Kawagishi T, Okuno Y, Kogawa K, Fukumoto S, et al.: Internal hemodynamic abnormalities in diabetic nephropathy measured by duplex Doppler sonography. Kidney Int 1997; 51: 1920-1927. – reference: 30) Simons PCG, Algra A, Bots ML, Grobbee D, van der Graaf Y, for the SMART Study Group: Commom carotid intima-media thickness and arterial stiffness: indicators of cardiovascular risk in high-risk patients: the SMART Study (Second Manifestations of ARTerial disease). Circulation 1999; 100: 951-957. – reference: 20) O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK: Carotid-arterial intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med 1999; 340: 14-22. – reference: 10) Hollander M, Bots ML, del Sol I, Koudstaal PJ, Witterman JCM, Grobbee DE, et al.: Carotid plaque increase the risk of stroke and subtypes of cerebral infarction in asymptomatic elderly; the Rotterdam Study. Circulation 2002; 105: 2872-2877. – reference: 15) O'Leary DH, Polak JF, Wolfson SK Jr., Bond MG, Bommer W, Sheth S, et al. on behalf of the CHS Collaborative Research Group: Use of sonography to evaluate carotid atherosclerosis in the elderly, the Cardiovascular Health Study. Stroke 1991; 22: 1155-1163. – reference: 12) Whisnant JP: Special report from the National Institute of Neurological Disorders and Stroke; Classification of cerebrovascular diseases III. Stroke 1990; 21: 637-676. – reference: 28) Okura T, Watanabe S, Miyoshi K, Fukuoka T, Higaki J: Intrarenal and carotid hemodynamics in patients with essential hypertension. Am J Hypertens 2004; 17: 240-244. – reference: 22) Mannami T, Baba S, Ogata J: Strong and significant relationship between aggregation of major coronary risk factors and the acceleration of carotid atherosclerosis in the general populaton of a Japanese city; the Suita Study. Arch Intern Med 2000; 160: 2297-2303. – reference: 27) Frauchiger B, Bock A, Eichlisberger R, Landmann J, Thiel G, Mihatsch MJ, et al.: The value of different resistance parameters in distinguishing biopsy-proved dysfunction of renal allografts. Nephrol Dial Transplant 1995; 10: 527-532. – reference: 3) 岩本俊彦: 頸動脈病変の臨床的意義. 日老医誌 2002; 39: 516-519. – reference: 13) Guidelines Subcommittee: 1999 World Health Organization-International Society of Hypertension guidelines for the management of hypertension. J Hypertens 1999; 17: 151-183. – reference: 21) Howard G, Sharrett AR, Heiss G, Evans GW, Chambless LE, Riley WA: Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-mode ultrasound. Stroke 1993; 24: 1297-1304. – reference: 4) Handa N, Matsumoto M, Maeda H, Hougaku H, Kamada T, for the OSACA Study Group: Ischemic stroke events and carotid atherosclerosis, results of the Osaka Follow-up Study for ultrasonographic assessment of carotid atherosclerosis (the OSACA Study). Stroke 1995; 26: 1781-1786. – reference: 17) Kitamura A, Iso H, Imano H, Ohira T, Sato S, Naito Y, et al.: Prevalence and correlates of carotid atherosclerosis among elderly Japanese men. Atherosclerosis 2004; 172: 353-359. – reference: 5) Nagai Y, Kitagawa K, Yamagami H, Kondo K, Hougaku H, Hori H, et al.: Carotid artery intima-media thickness and plaque score for the risk assessment of stroke subtypes. Ultrasound in Medicine and Biology 2002; 10: 1239-1243. – reference: 2) Nagao T, Sadoshima S, Ibayashi S, Takeya Y, Fujishima M: Increase in extracranial atherosclerotic carotid lesions in patients with brain ischemia in Japan; An angiographic study. Stroke 1994; 25: 766-770. – reference: 11) Nakatou T, Nakata K, Nakamura A, Itoshima T: Carotid haemodynamic parameters as risk factors for cerebral infarction in Type 2 diabetic patients. Diabet Med 2004; 21: 223-229. – reference: 14) The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997; 20: 1183-1197. – reference: 26) Arboix A, Marti-Vilalta JL: New concepts in lacunar stroke etiology: the constellation of small-vessel arterial disease. Cerebrovas Dis 2004; 17 (suppl 1): 58-62. – reference: 18) Burke GL, Evans GW, Riley WA, Sharrett AR, Howard G, Barnes RW, et al. for the ARIC Study group: Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults; the Atherosclerosis Risk in Communities (ARIC) study. Stroke 1995; 26: 386-391. |
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| Snippet | 【目的】頸動脈超音波検査で得られる指標が脳梗塞の発症予測因子となる報告は多い. 今回我々は断面調査にて生活習慣病を有するハイリスク高齢者におけるアテローム血栓性脳梗... |
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| Subtitle | 断面調査による検討 |
| Title | ハイリスク高齢者におけるアテローム血栓性脳梗塞およびラクナ梗塞と頸動脈超音波所見との関連 |
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| ispartofPNX | 日本老年医学会雑誌, 2005/11/25, Vol.42(6), pp.684-690 |
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