家族性高胆固醇血症患者跟腱厚度与颈动脉狭窄相关性分析

Correlative analysis of achilles tendon thickness and carotid artery stenosis in the patients with familiar hypercholesterolemia

目的:家族性高胆固醇血症(FH)患者跟腱厚度与颈动脉狭窄(CAS)相关性分析。方法:选取2014年6月至2016年6月,首都医科大学附属北京安贞医院门诊随访的成年FH先证患者137例,根据其跟腱厚度(ATT)的3分位数分组,记录临床资料,分析各组性别、年龄、TG、TC、HDL-C、LDL-C、hs-CRP、IMT及CAS间的差异,同时分析CAS的危险因素。结果:颈动脉狭窄组共29例,非狭窄组108例,颈动脉狭窄组与非狭窄组TC、HDL-C、LDL-C、hs-CRP、IMT及ATT比较,差异有统计学意义(P<0.05);性别、年龄及TG比较,差异无统计学意义(P>0.05)。按照ATT厚度3分位数分组,三组比较,年龄、TC、HDL-C、LDL-C、IMT及CAS差异有统计学意义(P<0.05);性别、TG、hs-CRP比较,差异无统计学意义(P>0.05);各组分别与第一组比较,第2组年龄、IMT和CAS以及第3组TC、HDL-C、LDL-C、IMT及CAS差异有统计学意义(P<0.05)。CAS的危险因素分析,低HDL-C<1.04mmol/L(OR=4.20,95%CI:1.56～11.30,P=0.005)及ATT(OR=2.56,95%CI:1.28～5.18,P=0.008)为CAS的危险因素;ATT≥0.85cm颈动脉狭窄风险增加,差异有统计学意义(OR=6.65,95%CI:1.52～29.01,P=0.012),0.56cm≤ATT<0.85cm颈动脉狭窄风险增加,差异无统计学意义(OR=2.59,95%CI:0.58～11.63,P=0.216)。结论:在FH患者中,跟腱增厚与TC、HDL-C、LDL-C、IMT及CAS关系密切,FH患者CAS与跟腱明显增厚(≥0.85cm)呈正相关性。

Objective: To carry out correlative analysis of Achilles tendon thickness(ATT) and carotid artery stenosis in the patients with familiar hypercholesterolemia(FH). Methods: 137 cases of adult patients with FH proband were selected that received outpatient follow-up of Beijing An Zhen Hospital affiliated to Capital Medical University from June 2014 to June 2016, and they were divided into the different groups according to tri-sectional quantile of Achilles tendon thickness, and the differences of gender, age, TG, TC, HDL-C, LDL-C, hs-CRP, carotid artery intima-media thickness(IMT) and carotid artery stenosis(CAS) in the various groups were analyzed, and the risk factors of carotid artery stenosis were analyzed simultaneously. Results: There were totally 29 cases of patients in carotid artery stenosis group and 108 cases in non stenosis group, and there was statistically significance(P<0.05) in the comparative differences of TC, HDL-C, LDL-C, hs-CRP, IMT and ATT;and there was no statistically significance(P<0.05) in the comparative differences of gender, age and TG. The patients were divided into the different groups according to tri-sectional quantile of ATT thickness, and the comparison were carried out in the three groups, and there was statistically significance(P<0.05) in the differences of age, TC, HDL-C, LDL-C, IMT and CAS;and there was no statistically significance(P<0.05) in the differences of gender, TG and hs-CRP;through the comparison between the other two groups and the first group, there was statistically significance(P<0.05) in the differences of age, IMT and CAS of the second group and TC, HDL-C, LDL-C, IMT and CAS of the third group. Through the analysis of the risk factors of carotid artery stenosis, it indicated that the low HDL-C<1.04 mmol/L(OR=4.20, 95%CI 1.56-11.30, P=0.005) and ATT(OR=2.56, 95%CI 1.28-5.18, P=0.008) were independent risk factors for carotid artery stenosis;there was statistically significance(OR=6.65, 95%CI 1.52-29.01, P=0.012) in increase of risk of carotid artery stenosis when ATT≥0.85 cm, and there was no statistically significance(OR=2.59, 95%CI 0.58-11.63, P=0.216) in increase of risk of carotid artery stenosis when 0.56 cm≤ATT<0.85 cm. Conclusions: In the patients with familiar hypercholesterolemia, Achilles tendon thickening is closely related to total cholesterol, high density lipoprotein cholesterol, low density fat cholesterol, carotid artery intima-media thickening and carotid artery stenosis, and significant Achilles tendon thickening(≥0.85 cm) was independently associated with the carotid artery stenosis in the patients with familiar hypercholesterolemia.