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冠心病及其合并2型 糖尿病患者的冠脉 CT影像特点分析*

作者:吴 刚

所属单位:四川省雅安市中医医院内二科 (四川 雅安 625000)

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摘要

目的 探讨冠心病及其合并2型 糖尿病患者的冠脉CT影像特点。方法 回 顾性分析2012年5月-2015年5月入我院就 诊的88例确诊冠心病患者临床资料,根据 其合并2型糖尿病情况将其分为糖尿病组 (n=32)和非糖尿病组(n=56)。两组受试者 均行128排极速螺旋CT冠状动脉血管造影 检查,对比其冠脉病变支数、冠脉病变分 布位置及病变钙化特点差异。结果 32例 糖尿病组患者左/右冠状脉主要血管节段 共检出96条病变血管,56例非糖尿病组患 者则共124条病变血管;两组冠脉双支病 变率、弥散性病变率及冠脉病变血管分布 情况比较均无统计学意义(P>0.05);糖 尿病组多支病变率及钙化斑块率分别为 46.9%和60.4%,均显著高于非糖尿病组的 17.9%和20.2%,差异均具有统计学意义(P <0.05)。结论 冠心病合并2型糖尿病患 者冠脉CT影像多存在钙化斑块及多支病变 特点,需引起临床重视。

Objective To investigate the coronary CT imaging features of patients with coronary heart disease and coronary artery disease complicated with type 2 diabetes mellitus. Methods The clinical data of 88 patients diagnosed with coronary heart disease who were treated in our hospital between May 2012 and May 2015 were analyzed retrospectively. According to the status of being complicated with type 2 diabetes mellitus, the patients were divided into diabetes group (n=32) and non-diabetes group (n=56). The two groups of subjects were examined by 128 speed spiral CT coronary angiography. The number of diseased coronary arteries, distribution of coronary artery lesions and characteristics of calcified lesions were compared. Results In 32 patients in diabetes group, 96 diseased blood vessels were detected in the main blood vessel segments of left/right coronary artery, and 124 diseased blood vessels were detected in 56 patients in the non-diabetic group. There were no significant differences in the rate of double diseased branches of coronary arteries, rate of diffuse lesions and the distribution of diseased coronary arteries between the two groups (P>0.05). The rates of multi-vessel lesions and calcified plaques in the diabetic group (46.9%, 60.4%) were significantly higher than those in the non-diabetic group (17.9%, 20.2%) (P<0.05). Conclusion Most coronary CT images of patients with coronary heart disease complicated with type 2 diabetes mellitus show calcified plaque and multi-vessel lesions, which needs clinical attention.

【关键词】冠心病;2型糖尿病;冠脉; CT影像特点

【中图分类号】R541.4

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.09.014

前言

冠状动脉造影(CAG)是当前临床诊断冠心病的金标准,可在帮助医 师及时掌握血管病变信息、推动后续治疗工作顺利开展等方面发挥积 极作用;但受其有创性影响,部分耐受不足、免疫力低下的受试群体 在临床应用中仍存在一定局限性。对此,越来越多学者将研究重点向 其他无创性影像检查技术方向转移,发现CTA可弥补CAG的不足,凭借 其无创、操作性强、扫描速度快等优势在冠心病的临床诊疗中发挥积 极作用[1]。相关研究认为,糖尿病作为冠心病的常见独立危险因素[2], 可对其病情发展造成影响。部分学者认为,合并糖尿病的冠心病患者 具有病变严重程度高、多支病变几率大等特点[3],需引起重视。本研 究为证实上述结论的准确性,回顾性分析88例确诊冠心病患者临床资 料,旨在通过CTA检查了解合并2型糖尿病的冠心病患者病情严重程度 及特点,为其针对性治疗措施的拟定提供依据,现报告如下。