基于冠状动脉计算机断层扫描血管造影的斑块特征及其衍生参数预测糖尿病与非糖尿病患者主要心血管不良事件应用价值的研究  

Application values of plaque features and derived parameters based on coronary CT angiography in predicting major adverse cardiovascular events in patients with and without diabetes mellitus

作　　者：陈铭 欧阳富盛 黄锡谊[2] 潘佳玲 王丽雯 周兰妮 胡秋根 郭保亮 CHEN Ming;OUYANG Fusheng;HUANG Xiyi(Department of Radiology,Shunde Hospital of Southern Medical University,Foshan 528308,China)

机构地区：[1]南方医科大学顺德医院放射科,佛山528308 [2]佛山市顺德区乐从医院检验科

出　　处：《中国糖尿病杂志》2025年第3期167-172,共6页Chinese Journal of Diabetes

基　　金：广东省医学科学技术研究基金(A2023204);广东省普通高校特色创新类项目(2023KTSCX022);佛山市自筹经费类科技创新项目(2220001004816、2220001004195);佛山市顺德区医学骨干人才培养项目(601001);佛山市顺德区乐从医院院内科研项目(A202303);南方医科大学顺德医院临床研究启动计划项目(CRSP2022005);南方医科大学顺德医院科研启动计划项目(SRSP2021021)。

摘　　要：目的 比较基于冠状动脉计算机断层扫描血管造影(CCTA)的斑块特征及计算机断层扫描(CT)衍生参数,在预测DM与非DM(non-DM)人群未来主要心血管不良事件(MACE)中的应用价值差异。方法 回顾性分析2016年6~11月于南方医科大学顺德医院行CCTA的患者425例,其中DM患者120例。根据随访中MACE发生情况,分为单纯DM组(n=81)、DM+MACE组(n=39)、non-DM组(n=244)、non-DM+MACE组(n=61),比较各组一般资料、生化指标及影像学参数,Cox比例风险回归分析两种人群中MACE发生的影响因素,受试者工作特征(ROC)曲线分析不同斑块特征及CT衍生参数对MACE的预测价值差异。结果 DM+MACE组冠状动脉钙化积分(CACS)、低衰减斑块(LAP)占比高于DM组(P<0.05),non-DM+MACE组正性重构(PR)、使用降压药占比、冠状动脉疾病报告和数据系统评分、CACS水平高于non-DM组,残余胆固醇、载脂蛋白B水平低于non-DM组(P<0.05)。Cox比例风险回归分析显示,CACS≥100(HR 2.151,95%CI 1.128~4.102,P=0.020)、LAP(HR 2.337,95%CI 1.032~5.290,P=0.042)是DM患者发生MACE的影响因素,PR(HR 124.305,95%CI 42.883~360.326,P<0.001)是non-DM患者发生MACE的影响因素。ROC曲线分析显示,CACS联合LAP预测DM患者1、3、5年内MACE的曲线下面积(AUC)分别为0.606、0.609和0.660;PR预测non-DM患者1、3、5年内MACE的AUC分别为0.862、0.927和0.806。CACS、LAP对DM患者MACE的预测价值在5年间较稳定,PR对non-DM人群MACE预测的应用价值在4年后出现明显下降。结论 DM患者不同斑块特征及CT衍生参数对MACE的预测价值存在差异,CACS联合LAP可评估DM患者MACE,PR预测non-DM人群MACE的价值较高。Objective To compare the application value of coronary computed tomography angiography(CCTA)based plaque characteristics and computed tomography(CT)derived parameters in predicting future major adverse cardiovascular events(MACE)between patients with and without diabetes mellitus.Methods A total of 425 patients who underwent CCTA in Shunde Hospital Affiliated to Southern Medical University from June 2016 to November 2016 were retrospectively analyzed.Patients were divided into DM group(n=120)and non-DM group(n=305)for follow-up.According to the occurrence of MACE during follow up,patients were divided into DM group(n=81),DM+MACE group(n=39),non-DM group(n=39),non-DM group(n=244)and non-DM+MACE group(n=61).The differences in general characteristics,biochemical index and parameters in imaging were compared among the four groups.Cox proportional hazards regression analysis was used to analyze the influencing factors for MACE in the two populations.The receiver operating characteristic(ROC)curve was used to analyze the difference in the predictive value of different plaque characteristics and CT-derived parameters for MACE.Results The levels of coronary artery calcification score(CACS),and the proportion of low-attenuation plaque(LAP)were higher in the DM+MACE group than in the DM group(P<0.05).The levels of positive reconstruction(PR),the proportion of antihypertensive drugs,CAD-RADS,CACS,residual cholesterol and apolipoprotein B were higher in the non-DM+MACE group than in the non-DM group(P<0.05).Cox proportional hazards regression analysis showed that CACS≥100(HR 2.151,95%CI 1.128~4.102,P=0.020)and LAP(HR 2.337,95%CI 1.032~5.290,P=0.042)were the influencing factors for MACE in patients with DM.PR(HR 124.305,95%CI 42.883~360.326,P<0.001)was the influencing factor for MACE in patients without DM.ROC curve analysis showed that the AUC of CACS combined with LAP were 0.606,0.609 and 0.660 for predicting MACE in DM patients within 1,3 and 5 years respectively.The AUC of PR for predicting MACE were 0.862,0.927,and 0.8

关 键 词：冠状动脉粥样硬化 糖尿病 主要心血管不良事件 冠状动脉计算机断层扫描血管成 

分 类 号：R541.4[医药卫生—心血管疾病]