64排螺旋CT冠状动脉血管成像和冠状动脉血管造影对老年冠心病合并2型糖尿病患者冠状动脉病变诊断的对比研究

Clinical Comparison Analysis of 64-MSCTA and Coronary Angiography for Detecting Coronary Stenosis in Elderly Patients with Coronary Artery Disease Combined with Type 2 Diabetes Mellitus

目的通过与冠状动脉血管造影比较,评价64排螺旋CT冠状动脉血管成像在老年冠心病合并2型糖尿病患者冠状动脉病变诊断中的价值。方法 2010年1月至2011年12月在昆明医科大学第一附属医院经64-MSCTA疑诊为冠心病且合并糖尿病的患者68例,1个月内行冠状动脉血管造影检查,将两种检查结果进行对比分析。结果 64排螺旋CT对诊断冠状动脉狭窄的灵敏度为90.67%,特异度为91.67%,阳性预测值80.73%,阴性预测值96.23%,准确率为91.39%,两种检查方法在诊断冠状动脉有无狭窄病变上差异无统计学意义(P<0.05)。68例合并糖尿病的老年冠心病患者冠脉斑块以软斑块最多见,占48.04%(98/204),引起管腔轻度狭窄的多为钙化性斑块(52%,26/50),引起管腔中重度狭窄的多为软斑块及混合性斑块(84.42%,130/154)。结论 64排螺旋CT冠状动脉成像技术是一种安全、简便、可靠的无创性检查技术,是评价冠状动脉病变的重要手段。

Objective To evaluate the diagnosis value of 64-muhislice spiral computed tomography angiography（64-MSCTA） for the assessment of coronary artery disease with type 2 diabetes mellitus in comparison with invasive coronary angiography. Methods Both 64-MSCTA and conventional coronary angi- ography（CAG） were performed in 68 elderly patients who were suspected of having coronary artery disease combined with Type 2 diabetes mellitus recruited from the patients in the First Affiliated Hospital of Kunming Medical University during January 2010 and December 2012. All the patients had coronary angiography in one month and the results were compared and analyzed. Results The sensitivity of 64-MSCTA for detecting coronary artery stenosis was 90.67% ,the specificity was 91.67%, veracity was 91.39%. The positive and negative predictive values were 80.73% and 96.23%, respectively. Further analysis showed no statistically significant difference in the discovery of coronary artery disease between 64-MSCTA and CAG（ P 〈 0.05 ）, According to the analysis of the 64-MSCTA,it was found that among 68 elderly patients with coronary artery disease and type 2 diabetes meIIitus, and the majority of coronary plaques were soft and unstable in nature （48.04% ,98/204 ）. Medium to severe lumen stenosis was caused by soft and complex plaques （84.42%, 130/ 154 ）while s!ight lumen stenosis was caused by calcified plaques（ 52% ,26/50 ）. Conclusion 64-MSCTA is a safe, reliable and noninvasive diagnostic technology which can be used as the preferred method of screening for coronary artery disease with type 2 diabetes mellitus.