冠心病合并糖尿病患者的冠状动脉CT血管成像特征

Coronary Computed Tomography Angiography Features in Coronary Heart Disease Patients with Diabetes Mellitus

目的为冠心病合并2型糖尿病患者心血管事件高发的原因提供影像学依据。方法对比分析合并糖尿病与未合并糖尿病的冠状动脉粥样硬化性心脏病患者的冠状动脉CT成像资料,比较两组间斑块类型、负荷及分布差异,总结糖尿病患者冠状动脉粥样硬化的影像学特征。结果合并2型糖尿病的30例冠心病患者中24例有2支或3支病变血管,而未合并糖尿病的冠心病组该情况只有13例(P<0.05),糖尿病冠心病组患者人均斑块节段总数比非糖尿病冠心病组多(2.92±2.76 vs 1.67±2.32,P<0.05)。右冠状动脉、左回旋支的斑块更多的出现在糖尿病冠心病组(2.83±1.90 vs 1.50±1.62,P<0.05;2.87±2.17 vs 0.67±1.35,P<0.01)。糖尿病冠心病组患者冠状动脉粥样硬化斑块更多为混合型斑块(1.83±1.37 vs 0.70±0.88,P<0.01)。结论冠心病合并2型糖尿病患者与非糖尿病冠心病患者间冠脉粥样硬化斑块特征存在差异;合并糖尿病者冠脉粥样硬化斑块较广泛并有较多混合斑块可能是其心血管事件较高发生的原因。

Objective To provide imaging basis for causes of higher incidence of cardiovascular events in coronary heart disease patients with type 2 diabetes mellitus( T2DM). And to understand diabetic coronary atherosclerosis imaging characteristics. Methods CT coronary angiography imaging data including the differences of plaque type,burden and the distribution in diabetic and nondiabetic patients with coronary atherosclerosis heart disease were compared by radiologist between two groups. The imaging characteristics of coronary atherosclerosis summarized in patients with diabetes. Results Patients with DM tended to have higher prevalence of 2-and 3-vessel disease( P < 0. 05). The total number of coronary segments with plaques of diabetes group were more than non-diabetic group( 2. 92 ± 2. 76 vs 1. 67 ± 2. 32,P < 0. 05). Right coronary artery and left circumflex of plaques of diabetes group were detected more than nondiabetic group( 2. 83 ± 1. 90 vs 1. 50 ± 1. 62,P < 0. 05; 2. 87 ± 2. 17 vs 0. 67 ± 1. 35,P < 0. 01). Also DM patients had a higher number of coronary segments with mixed plaques compared to nondiabetic patients( 1. 83 ± 1. 37 vs 0. 70 ± 0. 88,P < 0. 01) whereas no such differences were observed for noncalcified or calcified plaques. Conclusion Differences of characteristics of coronary atherosclerotic plaques were existed between diabetic and nondiabetic patients with coronary atherosclerosis heart disease. Coronary heart disease patients with diabetes mellitus have more wide coronary atherosclerotic plaques and more mixed plaques,this imaging characteristics was possibly associated with the higher morbidity and mortality of cardiovascular events.