2型糖尿病与冠脉钙化及主要心血管事件的关系

Effect of diabetes on coronary artery calcification and occurrence of major adverse cardiac event

目的研究糖尿病与非糖尿病患者冠脉钙化程度以及主要心血管事件的差异。方法回顾性分析2013年3月至2015年1月在河南省人民医院就诊的678例可疑冠心病的门诊患者,均行冠状动脉双源CT和生化检测,对所有符合入选标准的患者进行随访(4～20个月),记录主要心血管事件(MACE,包括死亡、心肌梗死、冠状动脉支架置入术、冠状动脉旁路移植术)的发生。采用Kaplan-meier进行生存率分析,logistic逐步回归分析MACE的相关因素。结果 (1)糖尿病组前降支(LAD)(P=0. 002)、回旋支(LCX)(P=0. 004)、右冠状动脉(RCA)(P <0. 001)和总钙化积分(T scores)(P <0. 001)明显大于非糖尿病组;(2)糖尿病组冠脉斑块(P <0. 001)、病变的冠脉支数(P <0. 001)及阻塞性斑块(P <0. 001)明显多于非糖尿病组;(3)糖尿病组患者累计生存生存率明显低于非糖尿病组(P <0. 001),差异有统计学意义;冠脉钙化积分越高,累计生存率越低(P <0. 001),差异有统计学意义。结论 2型糖尿病患者更容易发生冠脉血管狭窄、冠脉钙化以及主要心血管事件;2型糖尿病和冠脉钙化是主要心血管事件的危险因素。

Objective The purpose of this study was to investigate the differences in coronary artery plaque,coronary artery calcification (CAC)measured in outpatients with and without type 2diabetes,and the occurrence rate of a major adverse cardiac event (MACE)throughout follow -up with the same patients.Methods Six hundred seventy -eight outpatients with suspected CAD were enrolled in this study.Coronary artery plaque and CAC scores were detected and measured by dual -source computed tomography.The major MACE during the follow -up period (4.0-20months) was recorded and its relationship to type 2diabetes and CAC was investigated.The accumulative survival rate was analyzed by Kaplan -meier and logistic stepwise regression analysis was used to.analyze the related factors of MACE. Results The diabetes group had higher CAC scores in the left anterior descending(P =0.002),left circumflex(P = 0.004),and right coronary(P <0.001)arteries and total CAC burden (P <0.001)than the group without diabetes. The diabetes group had more diseased coronary segments (P <0.001)and more obstructed vessels (P <0.001)than the non -diabetes group.All patients in the diabetes group and all patients with higher CACs in both groups had a higher incidence rate of MACEs (P <0.001).Conclusion Patients with type 2diabetes have a higher prevalence of obstructive CAD,higher CAC scores,and a higher incidence rate of MACEs than those without diabetes.Diabetes and higher CAC scores were the important predictors of the occurrence of MACEs.