多层螺旋CT对老年糖尿病患者冠状动脉病变筛查的研究  

Application of multi-slice spiral CT in the screening of coronary artery lesions in elderly patients with diabetes mellitus

作　　者：陈晓亮[1] 陈馨亮 张素琴[3] 茅国群[4] 楼明芳[4] 张华冠 陈瑶[5] 章才干 王文玉 吴林生[1] 李娟[2] 金敏[1] 王宏雁[1] 

机构地区：[1]杭州师范大学附属医院干部科,310015 [2]杭州市肿瘤医院保健科,310002 [3]上海市第八人民医院中医科,200235 [4]浙江省立同德医院放射科,310012 [5]浙江省新华医院放射科,310005 [6]淳安中心威坪中心卫生院内科,311715 [7]浙江省关怀医院内科,310015

出　　处：《中华老年医学杂志》2017年第9期963-965,共3页Chinese Journal of Geriatrics

基　　金：杭州市卫生局B类课题（2007B0031）

摘　　要：目的评价多层螺旋CT（MSCT）在老年糖尿病患者冠状动脉（冠脉）病变筛查中的临床应用价值。方法136例老年患者，其中糖尿病组和非糖尿病患者各68例，分别行MSCT冠脉血管成像检查和冠脉造影（CAG）。分析各组患者冠脉病变特点，评价MSCT的灵敏度和特异性。结果糖尿病组患者非钙化性和钙化性斑块数均高于非糖尿病组，分别为14．7％（10例）和5．9％（4例）、69．1％（47例）与57．4％（39例），差异有统计学意义（P〈0．05），而混合性斑块低于非糖尿病组，且糖尿病组患者的冠脉病变多呈多支病变。MSCT诊断冠脉病变的敏感度为91．0％，特异度为95．0％，阳性预测值为93．0％，阴性预测值为96．0％。结论糖尿病患者具有更高的冠脉病变风险，MSCT可有效检测糖尿病患者的冠脉病变特点，是一种有效、无创、安全的筛查手段。Objective To evaluate the clinical value of multi-slice spiral CT （MSCT）in the screening of coronary artery lesions in elderly patients with diabetes mellitus. Methods MSCT and coronary angiography（CAG）were performed in 136 elderly patients（68 patients with diabetes and 68 patients without diabetes）. The number of diseased coronary segments and the plaque type （non- calcified,mixed and calcified）for each patient were determined. The characteristics of coronary lesions Were compared between patients with and without diabetes. The sensitivity and specificity of MSCT were evaluated. Results More noncalcified and calcified plaques and few ermixed plaques were observed in patients with diabetes, compared with patients without diabetes （noncalcified plagues; 10 cases or 14.7% vs. 4 cases or 5.9% ;calcified plagues：47 cases or 69.1% vs. 39 cases or 57.4%）（P〈 0.05）. In addition,diabetic patients showed a significantly higher frequency of multivessei disease（P〈 0.05）. Furthermore, MSCT was able to clearly show stenosis and plaque type in the trunk and branches of the coronary artery, with a sensitivity of 91.0%, a specificity of 95.0%, a positive predictive value of 93% and a negative predictive value of 96.0%. Conclusions Diabetes is associated with a higher risk of coronary artery disease. MSCT can effectively detect the characteristics of coronary artery disease in diabetic patients and is an effective, noninvasive, and safe screening method.

关 键 词：体层摄影术 螺旋计算机 冠状动脉疾病 糖尿病 

分 类 号：R541.4[医药卫生—心血管疾病]