冠心病合并2型糖尿病患者冠状动脉重构的研究

The study of coronary artery remodeling in CHD patients complicated with type 2 diabetes

目的:通过血管内超声明确合并2型糖尿病冠心病患者的冠状动脉重构特征,以及这一重构特征对管腔狭窄程度的影响。方法:62例冠状动脉造影显示单支局限性冠状动脉病变(管径狭窄>50%)的患者行病变血管的血管内超声(IVUS)检查,按有无2型糖尿病分为糖尿病组和非糖尿病组。定性分析斑块性质,区分软斑块和硬斑块,定量测量病变处外弹力膜横截面积(EEMCSA)、管腔横截面积(lumenCSA),计算斑块面积(EEMCSA-lumenCSA)、斑块负担,测量近端参考段EEM面积,计算重构指数,确定重构方向。结果:两组病人斑块性质无显著性差异(P>0.05)。糖尿病组病变血管EEMCSA显著小于非糖尿病组(P<0.05)。糖尿病组重构指数显著小于非糖尿病组(P<0.05)。两组均以负性重构为主,但糖尿病组负性重构更为常见。结论:合并2型糖尿病的冠心病患者病变血管以负性重构为主,并且较未合并糖尿病的冠心病患者负性重构更为常见,而且更严重。提示合并2型糖尿病的冠心病患者,其冠状动脉粥样硬化病变进展迅速,血管狭窄程度更严重。

Objective The aim of this study is to elucidate the coronary artery remodeling characteristic of CHD patients complicated with type 2 diabetes by intravascular ultrasound (IVUS) and its effect on severity of lumen stenosis. Methods 62 patients using IVUS whose lesions are localized on one vessel (a diameter stenosis of >50% on angiography) include CHD complicated with type 2 diabetes group and CHD complicated without type 2 diabetes group. They were performed by IVUS detection. We analyze these patients' plaque characteristic by qualitativeidentify soft and hard plaque.Then the lesion site and a proximal reference site are analyzed by quantitativeincluding external elastic membrane cross section area (EEM CSA) and lumen areacalculating plaque area,plaque burden and remodeling index(RI)then determining direction of arterial remodeling. Results The incidence of soft plaque and hard plaque in two groups are similar(P>0.05). The lesion EEM CSA and the RI are significantly less in CHD complicated with type 2 diabetes group than in CHD complicated without type 2 diabetes group(P<0.05). These two groups major in negative remodeling but negative remodeling is more frequent in CHD complicated with type 2 diabetes group than in CHD complicated without type 2 diabetes group. Conclusion Negative remodeling major in CHD patients complicated with type 2 diabetes. Negative remodeling is more frequent in the former than in CHD patients complicated without type 2 diabetes the RI of the former is less than that of the latter. This suggests coronary atherosclerosis of the former developed rapidly and vessel stenosis was more severe.