双源螺旋CT与外周血管超声在老年2型糖尿病合并冠心病患者中的临床应用

The Clinical Application of 64-section Dual Source CT and Ultrasonography in Aged Type 2 Diabetics with Coronary Heart Disease

目的运用64层双源CT冠状动脉血管成像和外周血管超声分析老年糖尿病合并冠心病患者冠状动脉、颈动脉、足背动脉病变性质等方面的特征.方法选取2010年12月至2013年10月期间在昆明医科大学附属延安医院老年科和心内科住院诊断为冠心病的患者共129例,根据有无2型糖尿病(T2DM)病史分为:老年冠心病组(n=69)和老年T2DM合并冠心病组(n=60).经64层双源螺旋CT检查、颈动脉和足背动脉超声检查对比2组患者冠状动脉、颈动脉、足背动脉病变性质的差异.结果 64-DSCT显示老年T2DM合并冠心病组冠脉病变以多支病变为主,与老年冠心病组比较,差异有统计学意义(P<0.05).老年T2DM合并冠心病组颈动脉和足背动脉超声斑块检出率分别为81.6%和55%,均高于老年冠心病组的65.2%和39.1%,差异有统计学意义(P<0.05).其中老年T2DM合并冠心病组易损斑块的检出率较老年冠心病组高,且老年T2DM合并冠心病组IMT、斑块积分均高于老年冠心病组,2组间比较差异有统计学意义(P<0.05).冠脉双支病变组和多支病变组外周血管斑块数较单支病变组多,差异有统计学意义(P<0.05).结论老年糖尿病合并冠心病患者冠脉病变以多支血管病变为主,颈动脉、足背动脉病变以易损斑块为主.颈动脉和足背动脉超声可以预测冠脉病变,外周血管斑块数越多,冠脉病变的支数越多.

Objective To analyze the vascular lesion of coronary artery,Carotid artery and dorsalis pedis artery by 64-section Dual source CT （64-DSCT） and Ultrasonography in aged type 2 diabetes mellitus （T2DM） with coronary heart disease （CHD）.Methods 129 patients with coronary heart disease （CHD） were divided into two groups：69 cases in elderly CHD group,and 60 cases in elderly T2DM with CHD group.The vascular lesion of coronary artery,Carotid artery and dorsalis pedis artery were measured by 64-DSCT and ultrasonography and compared between two groups.Results Compared with the elderly CHD group,coronary vessel disease was mainly multiple branches in elderly T2DM with CHD group,the difference was statistically significant （P＜0.05） The rate of the carotid and dorsalis pedis plaque of elderly T2DM with CHD group were 81.6％ and 55％,which were significantly higher than the elderly CHD group （65.2％ and 39.1％）,the difference was statistically significant （P ＜0.05）.Carotid intimal-medial thickness （IMT） and plaque scores in elderly T2DM with CHD group were higher than the elderly CHD group.The plaque number of peripheral vascular in coronary lesions of three branches and two branches groups were higher than the single branch group,the difference was statistically significant （P＜0.05） Conclusions The coronary lesions are mainly multivessel lesions in elderly T2DM with CHD patients.The Carotid and dorsalis pedis plaques are mainly vulnerable plaques in these patients.The more peripheral vascular plaque number,the more coronary lesion branches.