能谱CT冠状动脉血管成像对糖尿病患者合并冠状动脉病变的诊断价值研究

Study on the diagnostic value of spectral coronary computed tomography angiography in diabetes patients with coronary artery disease

目的能谱CT冠状动脉血管成像(CCTA)对糖尿病患者合并冠状动脉病变的预测价值。方法选取2020年8月至2022年8月福建医科大学附属福州市第一医院收治的88例疑似2型糖尿病(T2DM)合并冠状动脉病变患者,共随机选取352个冠脉节段,均接受能谱CCTA检查,以冠状动脉造影(CAG)为金标准,分析能谱CCTA对T2DM患者冠状动脉病变、冠脉狭窄程度及冠脉斑块类型的诊断效能。结果88例T2DM患者能谱CCTA诊断有56例合并冠状动脉病变,352个冠脉节段中,无狭窄134例,轻度狭窄115例,中度狭窄68例,重度狭窄10例,无斑块135例,钙化斑块26例,非钙化斑块103例,混合斑块67例。能谱CCTA诊断T2DM患者冠状动脉病变的准确度为88.64%,Kappa值为0.733;诊断冠脉轻度狭窄、中度狭窄、重度狭窄的准确度分别为95.74%、95.82%、97.73%,Kappa值分为0.900、0.857、0.702;诊断冠脉钙化斑块、非钙化斑块、混合斑块的准确度分别为96.01%、97.43%、98.24%,Kappa值分为0.754、0.964、0.969。结论能谱CCTA诊断T2DM患者冠状动脉病变、冠脉狭窄程度及冠脉斑块类型均具有较好的诊断效能,能为临床T2DM合并冠状动脉病变早期诊断、治疗工作提供一定参考,值得推广。

Objective To explore the diagnostic value of spectral coronary computed tomography angiography(CCTA)in diabetes patients with coronary artery disease.Methods A total of 88 patients with suspected type 2 diabetes mellitus(T2DM)complicated with coronary artery disease admitted to The First Hospital of Fuzhou affiliated to Fujian Medical University from August 2020 to August 2022 were selected.A total of 352 coronary segments were randomly selected and examined by spectral CCTA.Coronary angiography(CAG)was used as the gold standard to analyze the diagnostic efficacy of spectral CC TA on the severity of coronary artery disease,degree of coronary stenosis,and type of coronary plaques for T2DM patients.Results Among the 88 T2DM patients diagnosed by spectral CCTA,56 cases were complicated with coronary artery disease.Among 352 coronary segments,134 had no stenosis,115 had mild stenosis,68 had moderate stenosis,10 had severe stenosis,135 had no plaque,26 had calcified plaques,103 had noncalcified plaques,and 67 had mixed plaques.The accuracy of spectral CCTA in diagnosing coronary artery disease in T2DM patients was 88.64%,and the Kappa value was 0.733.The accuracies for diagnosing mild,moderate,and severe coronary stenosis were 95.74%,95.82%,and 97.73%,respectively.The corresponding Kappa values were 0.900,0.857,and 0.702.The accuracies for diagnosing coronary calcified plaques,noncalcified plaques,and mixed plaques were 96.01%,97.43%,and 98.24%,respectively.The corresponding Kappa values were 0.754,0.964,and 0.969.Conclusion Spectral CCTA has good diagnostic efficacy in diagnosing the severity of coronary artery disease,degree of coronary stenosis,and type of coronary plaques in T2DM patients.It can provide some reference for early diagnosis and treatment of T2DM combined with coronary artery disease in clin ical practice and is worth promoting.