冠状动脉CT造影结合颈动脉超声与血清学标志物评价2型糖尿病合并冠心病的临床意义  

Clinical significance of coronary arterial lesion evaluation by combining coronary computed tomography angiography with ultrasonography and inflammatory mediators in type 2 diabetics with coronary heart disease

作　　者：吴毅琴[1] 陈波[2] 朱常青[3] 吴天琼[4] 肖清华[4] 

机构地区：[1]广州医科大学附属广州市第十二人民医院心血管内科,510620 [2]广东省第二人民医院内分泌科 [3]广州医科大学附属广州市第十二人民医院内分泌科,510620 [4]广州医科大学附属广州市第十二人民医院医学影像科,510620

出　　处：《中国糖尿病杂志》2016年第10期908-913,共6页Chinese Journal of Diabetes

摘　　要：目的运用螺旋CT冠状动脉造影(CCTA)结合颈动脉超声、血清学标志物分析T2DM合并冠心病(CHD)患者冠状动脉与颈动脉病变的相关性,为评估冠状动脉早期病变提供诊断依据。方法选取2014年1月至2015年12月在两家医院心内科和内分泌科住院诊断为CHD患者95例,根据有无T2DM病分为单纯CHD组(n=45)和T2DM合并CHD组(n=50),比较两组冠状动脉、颈动脉病变程度,高敏C-反应蛋白(hsC-RP)及FFA的差异。结果 CCTA显示,T2DM合并CHD组以双支和3支冠脉病变为主,与单纯CHD组比较,差异有统计学意义(40.0%vs 24.5%,50.0%vs 31.0%,P<0.05),右冠状动脉、左回旋支斑块更多出现在T2DM合并CHD组,冠脉双支和3支病变组颈动脉斑块数较单支病变组多(P<0.05)。T2DM合并CHD组冠状动脉斑块、颈动脉斑块检出率、软斑块所占比例均高于单纯CHD组(P<0.05)。T2DM合并CHD组hsC-RP、FFA均高于单纯CHD组(P<0.01)。非钙化斑块组hsC-RP、FFA较钙化斑块组高(P<0.05)。随着冠状动脉病变分支增加,hsC-RP、FFA逐渐升高。Spearman相关分析表明,hsC-RP与FFA呈正相关(r=0.733,P<0.01),hsC-RP水平与冠状动脉病变支数均呈正相关(CHD组r=0.835,T2DM合并CHD组r=0.892;P<0.01)。结论CCTA显示,T2DM合并CHD冠脉斑块以软斑块和混合性斑块为主,冠状动脉病变广泛,颈动脉超声提示外周血管斑块数越多,冠状动脉病变支数越多,病变越严重。临床上联合CCTA、颈动脉超声及hsC-RP、FFA水平检测可提高T2DM合并CHD确诊率,降低假阳性,值得推广应用。Objective To evaluate the vascular lesion of coronary artery and carotid artery by combining coronary computed tomography angiography（CCTA）with ultrasonography and inflammatory mediators in type 2diabetes mellitus（T2DM）with coronary heart disease（CHD）. Methods 95 CHD patients were divided into two groups：45cases in CHD group and 50 cases in T2 DM with CHD group.The vascular lesion of coronary artery and carotid artery were measured by combining CCTA with ultrasonography and inflammatory mediators（hsC-RP and FFA）. Results Compared with CHD group,coronary vessel disease occurred on mainly two and three branches in T2 DM with CHD group（40.0%vs24.5%,50.0% vs 31.0%,P〈0.05）.Right coronary artery and left circumflex plaques in T2 DM withCHD group were detected more than in CHD group.The plaque number of peripheral vascular in two and three branches lesion groups were higher than in single branch group[（1.94±0.08）vs（3.01±1.05）vs（1.37±0.07）n,P〈0.05].The coronary plaques,the rate of carotid plaques and non-calcified plaque proportion in T2 DM with CHD group were higher than those in CHD group（162 vs 74,83.1%vs 62.7%,37.6% vs 6.7%,P〈0.05）.The levels of hsC-RP and FFA in T2 DM with CHD group were higher than CHD group[（8.36±4.49）vs（4.73±2.27）mg/L,（1.59±0.42）vs（0.71±0.33）mmol/L,P〈0.01].The levels of hsC-RP and FFA in patients with non-calcified plaque were significantly higher than those patients with calcified plaque.The hsC-RP and FFA levels gradually increased with higher degree of coronary lesions.HsC-RP level was positively correlated with FFA（r=0.733,P〈0.01）. Conclusion CCTA can effectively detect coronary plaque composition.The coronary lesions are mainly multivessel lesions in T2 DM with CHD patients.The coronary lesions plaques are mainly soft plaque and mixed plaque in these patients.The more peripheral vascular plaque number,the more coronary lesion branches.The level of inflammatory reaction is positively correlated with the extent of coron

关 键 词：冠状动脉CT造影 彩色多普勒超声 高敏C反应蛋白 游离脂肪酸 糖尿病 2型 

分 类 号：R541.4[医药卫生—心血管疾病] R587.1[医药卫生—内科学]