糖尿病与非糖尿病冠心病患者左冠状动脉主干粥样硬化性病变的对比研究

Comparison of the atherosclerotic changes in left main coronary artery between cardiac ischemic patients with diabetes and no-diabetes

目的利用血管内超声检测糖尿病患者与非糖尿病患者左冠状动脉主干部(左主干),阐述两者冠状动脉粥样硬化病变的特点。方法冠心病患者129例,其中合并糖尿病史40例,无糖尿病史89例。所有患者在进行左冠状动脉系统的介入检查和治疗时,给予左主干的血管内超声检查,并在每间隔1mm的超声断面上测量血管外腔面积、内腔面积、斑块面积以及钙化角度,然后将所有检测断面的相应数值相加,从而得到整个左主干的外腔容积、内腔容积、斑块体积和总的钙化负荷,最后比较各检测数据在合并糖尿病组和无糖尿病组的差别。结果不论在最小内腔面积的血管断面还是在整个左主干,血管内外腔和斑块大小在两组之间的差别无统计学意义,但糖尿病组的钙化阳性率明显高于非糖尿病组(67.5%对44.9%,P=0.022);定量测量最小内腔面积的血管断面上总钙化角度,糖尿病组显著高于非糖尿病组(P=0.027);整个左主干总的钙负荷,糖尿病组显著高于非糖尿病组。结论糖尿病患者与非糖尿病患者相比,即使左主干的内外径和斑块的大小不存在差异,管壁的钙化情况和斑块的构成却显著不同,前者钙化出现的阳性率和钙化程度均明显高于后者。

Objective To explore the atherosclerotic changes in left main coronary artery（LMCA） by intravascular ultrasound （IVUS）. Methods Forty diabetic and 89 non-diabetic patients with known coronary artery disease（CAD） were enrolled. Vessel, lumen, plaque areas and the angle of the calcium arc were measured at each cross section at an interval of 1 mm in the whole LMCA segment. The volumes of vessel, lumen, plaque and calcium were calculated as the sum of the values at each cross section. Results Both the planimetric and volumetric data on vessel, lumen and plaque were similar between diabetic and nondiabetic group. However, calcium was more prevalent in diabetic group than non-diabetic group （67.5 % vs 44.9%, P = tl. 022）. Quantitatively, the total arc of calcium at the cross section with minimum lumen area, and the average calcium arc of the vessel segment were all remarkably larger in diabetic group than nondiabetic group. Conclusions LMCA in CAD patients with diabetes is more frequently and more severely calcified than that in CAD patients without diabetes, although the vessel, lumen and plaque sizes are comparable.