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目的运用超声测定糖尿病(DM)患者颈动脉内-中膜厚度(IMT)、内-中膜横切面积(IMCSA),探讨DM患者颈动脉粥样硬化与冠脉粥样硬化的关系。方法 151例DM患者行冠状动脉造影后根据病变情况分为DM合并冠心病(CHD)组(92例)和单纯DM组(59例),再根据病变情况将DM合并CHD组分为DM合并单支病变组(20例)、DM合并双支病变组(39例)及DM合并多支病变组(33例)。超声测得所有患者双侧颈总动脉平均IMT,IMCSA。DM合并CHD组根据糖化血红蛋白(Hb A1C)水平,分为A组和B组,并比较两组的各项指标。结果 DM合并冠脉双支、多支病变组患者颈总动脉IMT高于单纯DM组,差异均有统计学意义(P<0.05),冠脉单支、双支、多支病变组患者颈总动脉IMCSA大于单纯DM组,差异均有统计学意义(P值分别为P<0.05,P<0.01,P<0.01)。随着冠脉病变支数的增加,双侧颈总动脉斑块发生率亦增加(P<0.05)。B组Fg(4.28±1.15)g/L,UA(319.9±96.7)μmol/L,Hs-CRP(3.27±0.61)明显高于A组(3.75±1.14)g/L,(281.3±77.4)μmol/L,(2.98±0.76),差异均具有统计学意义(P<0.05);B组中发生多支、双支、单支狭窄者分别为23例(46.0%)、15例(30.0%)、12例(24.0%),A组发生多支狭窄者仅8例(19.0%),双支狭窄者11例(26.2%),单支狭窄者23例(54.80%),B组发生冠脉狭窄程度明显高于A组,差异具有统计学意义(P<0.05)。B组患者颈动脉超声显示IMT增厚者43例(86.0%),而A组显示IMT增厚者19例(45.2%),差异具有统计学意义(P<0.05)。结论颈总动脉斑块检出结合颈总动脉平均IMT及IMCSA增加提示DM患者可能存在冠脉粥样硬化,有助于决定是否进行冠脉造影检查明确诊断;Hb A1C水平的高低与心血管危险因素密切相关,应严格控制其Hb A1C水平。
Objective To evaluate the relationship between carotid artery intima - media thickness (IMT) and medial - medial membrane cross - section (IMCSA) in patients with diabetes mellitus (DM) by ultrasound and to explore the relationship between carotid atherosclerosis and coronary atherosclerosis in patients with DM. Methods 151 DM patients undergoing coronary angiography were divided into two groups according to their disease: DM with coronary heart disease (CHD) group (n = 92) and DM group (n = 59) (20 cases), DM group with double-vessel disease (39 cases) and DM group with multi-vessel disease (33 cases). All patients with bilateral common carotid artery IMT, IMCSA. According to the level of Hb A1C, DM combined CHD group was divided into A group and B group, and the indexes of the two groups were compared. Results The IMT of common carotid artery in DM patients with double-vessel coronary artery and multi-vessel disease group was significantly higher than that of DM group (P <0.05). The total carotid artery length Arterial IMCSA was larger than that of DM group (P <0.05, P <0.01, P <0.01, respectively). With the increase of coronary lesion count, the incidence of bilateral common carotid artery plaque also increased (P <0.05). The Fg (4.28 ± 1.15) g / L, UA (319.9 ± 96.7) μmol / L and Hs-CRP in group B were significantly higher than those in group A (3.75 ± 1.14) g / L and 281.3 ± 77.4 μmol / (P <0.05). There were 23 cases (46.0%), 15 cases (30.0%) in group B with multiple branches, double branch and single branch stenosis, respectively , 12 cases (24.0%), only 8 cases (19.0%) had multiple stenosis in group A, 11 cases (26.2%) had double stenosis, 23 cases (54.80%) had single stenosis, Stenosis was significantly higher in group A, the difference was statistically significant (P <0.05). In group B, 43 cases (86.0%) had IMT thickened by carotid ultrasound, while 19 cases (45.2%) showed IMT thickened in group A, the difference was statistically significant (P <0.05). Conclusions The detection of common carotid artery plaque in combination with the increase of average IMT and IMCSA of carotid artery suggests that coronary artery atherosclerosis may exist in DM patients, which may be helpful to make a definite diagnosis of coronary angiography. The level of Hb A1C is associated with cardiovascular risk Factors are closely related, should be strictly controlled the level of Hb A1C.