2型糖尿病患者颈动脉斑块积分与无症状冠心病关系的研究

Association analysis between type 2 diabetes with asymptomatic coronary artery disease and carotid plaque integral

目的探讨T2DM患者颈动脉斑块积分与无症状冠心病(A-CAD)患病风险的关系。方法选取2013年1月至2018年11月于中山大学附属第八医院内分泌科住院的无冠心病(CAD)病史且无胸闷、胸痛等CAD症状的T2DM患者484例,根据冠脉非创伤性血管成像分为A-CAD组(n=245)及非CAD(NCAD)组(n=239),回顾性收集并分析临床资料及检查结果。结果A-CAD组下肢动脉病变(PAD)和颈动脉斑块的Crouse积分、半定量积分、等级积分均高于NCAD组(P<0.05或P<0.01)。Logistics回归分析显示,校正年龄、性别、吸烟、BP、BG、血脂、eGFR、口服ACEI/ARB类降压药和他汀类降脂药百分比等混杂因素后,PAD是T2DM合并A-CAD的独立危险因素,A-CAD发生风险是非PAD患者的2.09倍(P<0.01)。上述自变量不变的情况下加入半定量积分结果显示,PAD仍为T2DM合并A-CAD的独立危险因素(P<0.05);加入等级积分结果显示,等级积分是A-CAD的独立危险因素(P<0.01);加入Crouse积分结果显示,Crouse积分是A-CAD的独立危险因素(P<0.01)。结论颈动脉斑块Crouse积分与T2DM合并A-CAD独立相关,对A-CAD有较好的预测价值。

Objective To investigate the relationship between carotid plaque integral and asymptomatic coronary artery disease(CAD)in patients with type 2 diabetes mellitus(T2 DM).Methods A total of 484 T2DM patients without CAD history and chest tightness,chest pain and other symptoms related to CAD were enrolled in this study from the Department of Endocrinology of the Eighth Affiliated Hospital of Sun Yat-sen University from January 2013 to November 2018.The general clinical data and related examination results were collected retrospectively and analyzed.Results The prevalence of PAD,Crouse scores,semi-quantitative scores and grade scores of carotid plaque were significantly higher in T2DM with asymptomatic CAD group than in non-CAD group(P<0.05 or P<0.01).Adjusting for the confounder factors,such as age,sex,smoking,blood pressure,blood glucose,lipids,e GFR,the proportion of statins and a ACEI/ARB antihypertensive drugs,the logistics regression analysis showed that PAD was an independent risk factors for asymptomatic CAD in T2DM patients.The risk of asymptomatic CAD was 2.09 times higher in PAD patients than in non-PAD patients(P<0.01).Adding semi-quantitative scores to the above independent variables showed that PAD was still an independent risk factor for asymptomatic CAD(P<0.05).Adding grade scores to the above-mentioned independent variables showed that the grade scores was an independent risk factor for asymptomatic CAD(P<0.01).Finally,adding Crouse scores to the above independent variables shows that only Crouse scores is an independent risk factor for asymptomatic CAD(P<0.01).Conclusion There was an independent correlation between carotid plaque Crouse score and T2DM with asymptomatic CAD.Crouse score had a better predictive value for asymptomatic CAD.