2型糖尿病患者颈动脉内-中膜厚度和LDL/HDL胆固醇比值对冠状动脉狭窄的预测价值

The value of carotid intima-media thickness and LDL-to-HDL cholesterol ratio in predicting coronary stenosis in patients with type 2 diabetes mellitus

目的 探讨2型糖尿病患者颈动脉内-中膜厚度（IMT）和低密度脂蛋白（LDL）/高密度脂蛋白（HDL）胆固醇比值对冠状动脉（冠脉）狭窄的预测价值.方法 112例2型糖尿病患者根据冠脉造影结果分成冠心病组（冠脉狭窄≥50％,67例）和对照组（冠脉狭窄0～49％,45例）,超声检测颈动脉最大IMT（max-IMT）,抽血检测LDL、HDL胆固醇水平.结果 冠心病组max-IMT、LDL/HDL均明显大于对照组[（2.65±0.75）mm比（1.59±0.47）mm,3.1±0.9比2.5±0.7,均P＜0.05].Spearman秩相关分析显示,max-IMT和冠脉狭窄率呈正相关关系（r=0.46,P＜0.05）.ROC曲线分析显示,max-IMT、LDL/HDL和二者联合指标预测冠脉狭窄的曲线下面积（AUC）分别为0.702、0.617和0.888.结论 2型糖尿病患者颈动脉max-IMT、LDL/HDL与冠脉狭窄密切相关,联合max-IMT和LDL/HDL可更好预测冠脉狭窄.

Objective To explore the value of carotid intima-media thickness and LDL-to-HDL cholesterol ratio in predicting coronary stenosis in patients with type 2 diabetes mellitus. Methods One hundred and twelve patients with type 2 diabetes mellitus underwent coronary angiography were divided into two groups according to the percent of coronary stenosis, the coronary heart disease group （stenosis≥50%, n=67） and the control group（stenosis 0-49%, n=45）. The maximum carotid intima-media thickness（max-IMT） was detected by external carotid ultrasound. Low-density lipoprotein （LDL） cholesterol and high-density lipoprotein （HDL） cholesterol was determined from blood samples. Results Max-IMT and LDL/HDL ratio in the coronary heart disease group were significantly greater than in the control group [ （2.65±0.75）ram vs （1.59±0.47）ram, 3.1±0.9 vs 2.5±0.7, all P〈 0.05 ]. Spearman＇s rank correlation analysis showed that a significant correlation was found between max-IMT and coronary artery stenosis （r=0.46, P〈0.05）. Areas under the curves （AUC） in receiver operating characteristic （ROC） curve analysis of max-IMT, LDL/HDL, and these two parameters combined were 0.702, 0.617 and 0.888 respectively, for predicting coronary artery stenosis. Conclusion In type 2 diabetic patients, max-IMT and LDL/ HDL are closely associated with coronary stenosis, and the combination of max-IMT and LDL/HDL improve the prediction of coronary artery stenosis.