Fenotipurile carotidiene si relatia cu ateroscleroza
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Transcript of Fenotipurile carotidiene si relatia cu ateroscleroza
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FENOTIPURILFENOTIPURILE E CAROTIDIENE CAROTIDIENE SI RELATIA CU SI RELATIA CU
ATEROSCLEROZAATEROSCLEROZA
Alexandru AndritoiuSp. Militar Craiova
Dept. Medicina Interna
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ARICLADARICLAD (Atherosclerosis Risk in Communities Limited Acces Data)
Subset of ARIC Study
1987-1998
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Fenotipurile CarotidieneFenotipurile Carotidiene
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Rezultate din ARICLAD StudyRezultate din ARICLAD Study
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Relatia fenotip Car -StrokeRelatia fenotip Car -Stroke
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Lot de studiuLot de studiu
• NN = 1295 subiecti
• VarstaVarsta 40-90 ani (decade)
• Sex M/FSex M/F (716 vs. 579)
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Metoda de studiuMetoda de studiu
US CARUS CAR
• MasuratoriMasuratori
• Diametrul intern ACC (mm) - Mean+/-DS
• CIMT (mm) - Mean +/-DS
• Prezenta placilor ATS
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ObiectiveObiective
• Identificarea fenotipurilor CAR
• Asocierea fenotipurilor cu frecv. placilor ATS
• Analiza pe grupe de varsta si sex
Prelucrarea statistica a datelor MedCalc (software)
• Valori medii +/-DS• Limita max. Diam. ACC; CIMT - Mean+2DS• Corelatia Pearson: Fenotip - frecv. Placilor ATS• t-Student; p<0.05
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Dinamica D (mm) pe decade de varsta
0
1
2
3
4
5
6
7
8
9
40-49 50-59 60-69 70-79 80-90
D (mm)
D max
Sex F ; N = 579
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Dinamica D (mm) pe decade de varsta
0
1
2
3
4
5
6
7
8
9
40-49 50-59 60-69 70-79 80-90
D (mm)
D max
Sex M ; N = 716
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Dinamica D (mm) pe decade de varsta
0
1
2
3
4
5
6
7
8
40-49 50-59 60-69 70-79 80-90
F
B
Sex F/M ; N = 1295
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Dinamica CIMT (mm) pe decade de vastaDinamica CIMT (mm) pe decade de vasta
0
0,2
0,4
0,6
0,8
1
1,2
40-49 50-59 60-69 70-79 80-90
CIMT (mm)
CIMT max
Sex F; N = 579
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Dinamica CIMT (mm) pe decade de vastaDinamica CIMT (mm) pe decade de vasta
0
0,2
0,4
0,6
0,8
1
1,2
1,4
40-49 50-59 60-69 70-79 80-90
CIMT (mm)
CIMT max
Sex M; N = 716
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Dinamica CIMT (mm) pe decade de vastaDinamica CIMT (mm) pe decade de vasta
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
40-49 50-59 60-69 70-79 80-90
F
B
Sex F/M; N = 1295
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Relatia CIMT – Relatia CIMT – VVarstaarsta (ani) (ani)
0
0,2
0,4
0,6
0,8
40-49 50-59 60-69 70-79 80-89
Ani
CIM
(m
m)
N = 405 subiecti; varsta 40-90ani
Andritoiu A 2009
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CIMT sex M > CIMT sex FCIMT sex M > CIMT sex F
0,42
0,44
0,46
0,48
0,5
0,52
0,54C
IM (
mm
)
B F
p<0.01
N = 405 subiecti; (237 B vs 168 F)varsta 40-90 ani
Andritoiu A 2009
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Relatia dintre grosimea CIM Relatia dintre grosimea CIM si prezenta placilor ATSsi prezenta placilor ATS
0,44
0,63
0
0,2
0,4
0,6
0,8
Placa Non-Placa
r = 0.40; p<0.0001; IC95% 0.281-0.514
N = 405 subiecti; varsta 40-90 ani
Andritoiu A 2009
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Distributia fenotipuri CAR (sex F)
Grupa de varsta (ani)
Fenotip I Fenotip II Fenotip III Fenotip IV
40-49 (n=86) 86 0 0 0
50-59 (n=185) 171 5 7 2
60-69 (n=180) 163 5 9 3
70-79 (n=116) 97 9 8 2
80-90 (n=11) 9 1 1 0
N=578 526 20 25 7
Nr. cazuri pe decade de varsta
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Distributia fenotipuri CAR (sex M)
Grupa de varsta (ani)
Fenotip I Fenotip II Fenotip III Fenotip IV
40-49 (n=140) 129 10 1 0
50-59 (n=238) 205 28 4 1
60-69 (n=172) 124 34 3 11
70-79 (n=131) 85 28 10 8
80-90 (n=35) 23 8 4 0
N=716 566 108 22 20
Nr. cazuri pe decade de varsta
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Distributia fenotipurilor CAR (sex Distributia fenotipurilor CAR (sex F)F)
1.21%4.32%3.46%
91%I
II
III
IV
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Distributia fenotipurilor CAR (sex Distributia fenotipurilor CAR (sex MM))
1.21%4.32%
3.46% 79%
I
II
III
IV
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Frecv. placilor pe fenotipuri CAR Frecv. placilor pe fenotipuri CAR
85.7%
70%68%
29.46%
95%
77%
58%
39%
I II III IV
F
B
Diam N Diam > Diam N Diam > CIMT N CIMT N CIMT > CIMT>
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Fenotip IFenotip I
• Diam. ACC 5.7 mm• CIMT 0.4 mm
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Fenotip IFenotip I
Diam. ACC 6.2 mmCIMT 0.9 mmPlaca (in 30-40% din cazuri)
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Fenotip I cu placa (++)Fenotip I cu placa (++)
Pacienta in varsta de 90 ani fenotip I
Diametru ACC 6.7 mm
CIMT 0.8 mm ecogen
Placa parietala la bifurcatie
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Fenotip I – cu placaFenotip I – cu placa
• Diam. ACC 6.9 mm
• CIMT 0.8 mm
• Placa parietala
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Fenotipul IIFenotipul II
• Diam. ACC 9.3 mm• CIMT 0.7 mm• Fara placi
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Fenotip II cu placaFenotip II cu placa
DP, sex M, 80 ani
• Diam ACC=7.9 mm
• CIMT 0.5 mm
• Placa 60-70% din cazuri
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Fenotip IIIFenotip III
• Diam. ACC 5.6 mm• CIMT 1.6 mm• Placa 70-80% din cazuri
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Fenotip IVFenotip IV
Diam. ACC 7.5 mm CIMT 1.2 mm
Placi parietale ,,la risc,,la bifurcatie (85-95% din cazuri)
D
CIMT
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ConcluziiConcluzii
Fenotipul IFenotipul I• cel mai frecvent• asociaza placi in 30% din cazuri !!!
Fenotipul II si IIIFenotipul II si III• diferenta nesemnificativa in frecv. placilor (70%)
Fenotipul IVFenotipul IV • este cel mai rar, dar cu frecv. placilor cea mai
mare (85-95%)