64排螺旋CT血管成像对Ⅱ型糖尿病合并冠心病的筛选价值

Value of coronary computed tomography angiography in screening coronary heart disease combined with type 2 diabetes mellitus

【目的】探讨64排螺旋CT冠状动脉成像(computed tomography angiography,CTA)对无冠心病史的Ⅱ型糖尿病(T2DM)患者冠状动脉硬化的筛选价值。【方法】收集2010年2月至2012年2月我院收治的无典型胸痛症状的Ⅱ型糖尿病患者220例,行64排螺旋CT冠脉CTA,选取其中病变较重的患者2周内行选择性冠状动脉造影(coronary angiography,CAG),分析CTA诊断冠状动脉狭窄的准确性。【结果】在顺利完成CTA检查的210患者中20例冠状动脉基本正常,52例冠状动脉轻度钙化伴狭窄,138例出现单支或多支病变。与CAG结果比较分析,CTA对2型糖尿病合并冠心病患者冠状动脉狭窄的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为93.4%、94.7%、86.2%、97.6%、94.3%。【结论】冠状动脉CTA是诊断冠状动脉病变可靠、无创的检查方法,对2型糖尿病患者早期筛选无症状的冠心病具有极大的价值。

[Objective]To evaluate the value of coronary CTA in screening coronary heart disease （CHD） combined with type 2 diabetes mellitus （T2DM）. [Method]A total of 220 cases diagnosed as T2DM without typical symptoms of chest pain admitted from Feb 2010 to Feb 2012 were enrolled in this study. 64-slice spiral CT angiography was performed, patients with severe coronary artery stenotic lesions were chosen for coronary angiography （CAG） with in 2 weeks after CTA. The accuracy of CTA in the diagnosis of coronary artery stenosis was evaluated. [Results] 210 cases were completed as the CTA inspection. Among them, 20 cases had normal coronary arteries, 52 cases were diagnosed slight coronary artery stenosis combined with calcification, coronary arteries of 138 cases showed single or muhiple arterial stenotic lesions. Compared with CAG, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CTA were 93.4%, 94.7%, 86.2%, 97.6%, 94.3% respectively. [Conclusions] Coronary CTA is a reliable and non-invasive method for screening CHD in T2DM patients without typical symptoms of coronary heart disease.