心肌血流储备分数评价糖尿病患者冠状动脉临界病变的可靠性

Reliability of fractional flow reserve on diagnosis of intermediate coronary stenosis in patients with diabetes

目的通过测定冠状动脉中等程度狭窄的糖尿病和非糖尿病患者的心肌血流储备分数（fractional flow reserve,FFR）来评估糖尿病对FFR检测的影响。方法本研究入组68例冠状动脉造影明确诊断为冠状动脉粥样硬化性心脏病（冠心病）,且经量化冠状动脉造影（quantitative coronary angiography,QCA）诊断为中等程度狭窄的患者,分为糖尿病组和非糖尿病组;再根据病变处管腔狭窄程度进一步细分为50%～60%亚组和60%～70%亚组;根据糖化血红蛋白（glycated hemoglobin,GHb）水平分为GHb≥7.0亚组和GHb〈7.0亚组。以三磷腺苷（ATP）为冠状动脉扩张剂。比较每两组间FFR的测量值（两次取平均值）及冠状动脉扩张前后的FFR差值。结果冠状动脉狭窄程度相似的糖尿病组和非糖尿病组的FFR比较,差异无统计学意义[50%～60%亚组：（0.84±0.06）vs.（0.86±0.08）,P=0.45;60%～70%亚组：[（0.76±0.09）vs.（0.81±0.07）,P=0.061]。糖尿病GHb≥7.0亚组的FFR高于糖尿病GHb〈7.0亚组,差异有统计学意义[（0.77±0.06）vs.（0.72±0.11）,P〈0.05]。结论糖尿病对测定中等程度狭窄的冠状动脉的FFR没有明显影响,糖尿病且GHb≥7.0患者的FFR较GHb〈7.0患者高。

Objectives To assess the impact of diabetes mellitus on the measurement of fractional flow reserve（FFR） by measuring FFR of the intermediate coronary lesions in patients with and without diabetes. Methods Totally 68 patients with intermediate coronary stenosis who had undergone FFR measurement were included in the study. Lesion severity was determined by quantitative coronary angiography（QCA）. Patients were divided into groups according to the presence（group 1） or absence（group 2） of diabetes mellitus. Then,patients were further categorized according to the degree of luminal narrowing caused by the lesion（50%-60% subgroup and 60%-70% subgroup）,and to the glycated hemoglobin（GHb） level（GHb≥7.0 subgroup and GHb〈 7.0 subgroup）. After dilatation induced by adenosine triphosphate（ATP）,FFR values were compared in each category. Results There was no difference between the FFR values of diabetic and nondiabetic patients who had coronary lesions with similar degree of luminal narrowing（50%-60% subgroup：（0.84±0.06）vs.（0.86 ±0.08）,P =0.45; 60%-70% subgroup ： [（0.76 ±0.09） vs.（0.81 ±0.07）,P =0.061 ]. FFR of GHb ≥7.0subgroup was significantly higher than that of GHb 〈7.0 subgroup [（0.77 ±0.06） vs.（0.72 ±0.11）,P〈0.05 ].Conclusions The presence of diabetes mellitus does not have a significant impact on FFR values in coronary stenosis of intermediate severity. FFR of diabetic patients with GHb ≥7.0 is higher than that of patients with GHb7.0.