基于CCTA评估老年T2DM患者冠脉病变程度及其与血脂的关系  

Evaluation of the severity of coronary artery lesions and its relationship with blood lipids in elderly patients with T2DM based on CCTA

作　　者：肖俊成 张汇斌 谢玉海[1] 高续 蒋哲 哈九大[1] 刘伟 XIAO Juncheng;ZHANG Huibin;XIE Yuhai;GAO Xu;JIANG Zhe;HA Jiuda;LIU Wei(Department of Radiology,Taihe County People's Hospital,Fuyang,Anhui,China,236600)

机构地区：[1]安徽省太和县人民医院放射影像科,安徽阜阳236600

出　　处：《分子诊断与治疗杂志》2025年第2期358-361,365,共5页Journal of Molecular Diagnostics and Therapy

基　　金：阜阳市自筹经费科技项目(FK202081065)。

摘　　要：目的基于冠状动脉CT血管造影(CCTA)评估老年2型糖尿病(T2DM)患者冠脉病变程度及其与血脂的关系。方法选择太和县人民医院2021年2月至2024年2月收治的83例拟诊冠脉病变的T2DM患者,所有患者均进行CCTA、冠状动脉数字减影血管造影(DSA)检查及血脂4项检查。DSA检查结果为金标准,狭窄率<50%为轻度、50%≤狭窄率<75%为中度、狭窄率≥75%为重度,评估不同狭窄程度血管的管腔内衰减梯度(TAG)差异,采用受试者工作特征曲线(ROC)分析TAG诊断血管中重度狭窄的效能;分析血脂水平与T2DM患者冠脉血管狭窄程度及TAG的关系;对比不同方法诊断T2DM患者冠脉血管中重度狭窄的结果,并采用配对四表格卡方检验分析各诊断方法与金标准的一致性。结果本组83例T2DM患者,共249支主干血管,DSA检查结果显示:60支血管正常、39支血管轻度狭窄、80支血管中度狭窄、70支重度狭窄。轻度狭窄血管的TAG>中度狭窄血管>重度狭窄血管,比较差异有统计学意义(P<0.05);ROC曲线分析显示,TAG诊断冠脉血管中重度狭窄的效能较高(P<0.05)。相关性分析显示,冠脉狭窄程度与TC、TG、LDL-C水平呈正相关(P<0.05),与HDL-C呈负相关(P<0.05);TAG与TC、TG、LDL-C水平呈负相关(P<0.05),与HDL-C呈正相关(P<0.05)。配对四表格卡方检验显示,CCTA目测直径法+TAG+血脂联合检测的准确率最高,与DSA结果高度一致(P<0.05)。结论CCTA目测直径法联合TAG、血脂指标可有效诊断T2DM患者冠脉主干血管中重度狭窄。Objective To evaluate the degree of coronary artery lesion in elderly patients with type 2 diabe tes mellitus(T2DM)based on coronary CT angiography(CCTA)and its relationship with blood lipids.Methods From February 2021 to February 2024,83 patients with T2DM who were suspected of coronary artery lesion were selected at Taihe County People's Hospital.All patients received CCTA,digital subtraction angiography(DSA)and four examinations of blood lipids.DSA examination was used as the gold standard,and the stenosis rate<50%was taken as mild degree,50%≤stenosis rate<75%as moderate degree and stenosis rate≥75%as severe degree,and the difference in transluminal attenuation gradient(TAG)in vessels with different stenosis degrees was assessed.The receiver operating characteristic curve(ROC)was applied to analyze the efficiency of TAG in the diagnosis of moderate-to-severe vascular stenosis.The relationship between blood lipids levels and coronary artery stenosis degree and TAG in T2DM patients was analyzed,and the results of different diagnostic methods for the diagnosis of moderate-to-severe coronary artery stenosis in patients with T2DM were compared,and the consistency of each diagnostic method with the gold standard was analyzed by paired four-table chi-square test.Results There were 249 main vessels in 83 patients with T2DM.DSA showed that 60 vessels were normal,39 vessels had mild stenosis,80 vessels had moderate stenosis,and 70 vessels had severe stenosis.The TAG was observed as mild stenosis vessel>moderate stenosis vessel>severe stenosis vessels,with a statistical significance(P<0.05).The ROC curve analysis revealed that TAG had a high efficiency in diagnosing moderate-to-severe coronary artery stenosis(P<0.05).Correlation analysis suggested that the degree of coronary artery stenosis was positively correlated with TC,TG,and LDL-C levels(P<0.05),and was negatively correlated with HDL-C(P<0.05).TAG was negatively correlated with TC,TG,and LDL-C levels(P<0.05),and was positively correlated with HDL-C(P<0.05).Pair

关 键 词：2型糖尿病 冠状动脉狭窄 冠状动脉CT血管造影 血脂 

分 类 号：R587.1[医药卫生—内分泌] R543.3[医药卫生—内科学]