2型糖尿病患者下肢血管粥样硬化斑块超声表现与作为阻塞性冠状动脉疾病和心血管事件预测因子的临床价值

Ultrasonic manifestations of lower limb atherosclerotic plaque in patients with type 2 diabetes mellitus and its clinical value as a predictor of obstructive coronary artery disease and cardiovascular events

目的 分析2型糖尿病(T2DM)患者下肢血管粥样硬化斑块的超声表现与作为阻塞性冠状动脉疾病及心血管事件预测因子的临床价值。方法 90例T2DM伴冠状动脉粥样硬化性心脏病(CHD)患者设为CHD组,结合冠状动脉造影结果分为单支组、双支组、三支组,各30例;另选取同期90例健康体检者设为对照组。比较四组基线资料;观察下肢动脉超声分级结果;比较四组下肢血管内-中膜厚度(IMT)及下肢动脉超声分级结果;分析T2DM伴CHD患者心血管事件发生的影响因素。结果 四组的肌酸激酶、肌酸激酶同工酶、甘油三酯水平比较,差异具有统计学意义(P<0.05)。三支组的肌酸激酶、肌酸激酶同工酶、甘油三酯水平高于双支组、单支组、对照组,双支组高于单支组、对照组,单支组高于对照组,差异具有统计学意义(P<0.05)。CHD组下肢血管超声显示无粥样硬化19例,27例存在下肢动脉硬化,19例下肢动脉狭窄<50%/斑块、25例下肢动脉狭窄≥50%/闭塞。四组下肢IMT及下肢动脉超声分级比较,差异具有统计学意义(P<0.05)。三支组的下肢IMT(1.64±0.45)mm大于双支组的(1.30±0.34)mm、单支组的(1.02±0.26)mm、对照组的(0.80±0.15)mm,双支组大于单支组、对照组,单支组大于对照组,差异具有统计学意义(P<0.05)。伴随冠状动脉病变支数增多,下肢动脉超声分级相应升高,差异具有统计学意义(P<0.05)。T2DM伴CHD患者发心血管事件12例(发生组),未发心血管事件78例(未发生组)。发生组的下肢IMT、Gensini积分大于未发生组,下肢动脉超声分级差于未发生组,差异具有统计学意义(P<0.05)。Logistic回归分析显示,高下肢IMT、高Gensini积分、高下肢动脉超声分级是T2DM伴CHD患者心血管事件发生的独立危险因素(P<0.05)。结论 T2DM患者冠状动脉病变分支越多,下肢血管彩超检查显示的IMT及下肢血管硬化程度越高;T2DM伴CHD患者下肢血管粥样硬化、冠状动脉病变越严重,越易发生心血管事件。结合T2DM患者下肢血管粥样硬化斑块的超声表现能对阻塞性冠状动脉疾病及心血管事件发挥一定的预测价值。

Objective To analyze the ultrasonic manifestations of lower limb atherosclerotic plaque in patients with type 2 diabetes mellitus(T2DM)and its clinical value as a predictor of obstructive coronary artery disease and cardiovascular events.Methods 90 patients with T2DM with coronary atherosclerotic heart disease(CHD)were set as the CHD group,and divided into single-vessel group,double-vessel group and triple-vessel group combined with the coronary arteriography results,with 30 cases in each group.Another 90 patients with healthy physical examination were selected as the control group.The baseline data of the four groups were compared;the ultrasound grading of lower limb arteries were observed;the intima-media thickness(IMT)of lower limbs and ultrasound grading of lower limb arteries in the four groups were compared;the factors influencing the occurrence of cardiovascular events in patients with T2DM and CHD were analyzed.Results There were statistically significant differences in creatine kinase,creatine kinase isoenzyme and triglyceride levels among the four groups(P<0.05).The levels of creatine kinase,creatine kinase isoenzyme and triglyceride in three-vessel group were higher than those in double-vessel group,single-vessel group and control group;the double-vessel group was higher than the single-vessel group and the control group;the single-vessel group was higher than the control group;the differences were statistically significant(P<0.05).In the CHD group,ultrasound of lower limb vessels showed no atherosclerosis in 19 cases,27 cases had lower limb atherosclerosis,19 cases had lower limb artery stenosis<50%/plaque,and 25 cases had lower limb artery stenosis≥50%/occlusion.There were statistically significant differences in IMT of lower limbs and ultrasound grading of lower limb arteries among the four groups(P<0.05).The IMT of lower limbs of(1.64±0.45)mm in the three-vessel group was higher than that of(1.30±0.34)mm in the two-vessel group,(1.02±0.26)mm in single-vessel group and(0.80±0.15)mm in the control group;the double-vessel group was larger than the single-vessel group and the control group;the single-vessel group was greater than the control group;the differences were statistically significant(P<0.05).With the increase of the vessels of coronary artery lesions,the ultrasound grading of lower limb arteries was increased,and the difference was statistically significant(P<0.05).Among T2DM patients with CHD,12 cases had cardiovascular events(occurrence group)and 78 cases had no cardiovascular events(non occurrence group).The IMT and Gensini scores of lower limbs in the occurrence group were higher than those in the non-occurrence group,and the ultrasound grading of lower limb arteries was worse than that in the non-occurrence group.The differences were statistically significant(P<0.05).Logistic regression analysis showed that high IMT of lower limb,high Gensini score and high ultrasound grading of lower limb arteries were independent risk factors for cardiovascular events in patients with T2DM and CHD(P<0.05).Conclusion The more vessels of coronary artery lesions in T2DM patients,the higher IMT value and the degree of lower limb arteriosclerosis displayed by lower limb vascular ultrasound;the more serious the lower limb atherosclerosis and coronary artery disease in T2DM patients with CHD,the more prone to cardiovascular events.Combined with the ultrasonic manifestations of lower limb atherosclerotic plaque in T2DM patients,it can play a certain predictive value for obstructive coronary disease and cardiovascular events.