红细胞分布宽度对行急诊PCI的ACS患者的预后价值

目的 研究红细胞分布宽度(RDW)与行急诊经皮冠状动脉介入治疗(PCI)的急性冠脉综合征(ACS)患者预后的关系.方法 搜集本院2009年1～8月116例因ACS入院并行急诊PCI术的患者资料,根据入院24 h首次RDW中位数(12.8%)检测结果,将患者分为RDW≥12.8%和RDW＜12.8%组,观察其住院期间及出院1年内发生心肌缺血、心力衰竭、心源性死亡等心血管不良事件的差别.结果 共纳入符合条件ACS患者116例,在校正血红蛋白含量(Hb)、平均红细胞体积(MCV)、性别、年龄、高血压、糖尿病等因素影响后,RDW升高仍是行急诊PCI术的ACS患者住院期间及出院1年内发生心血管不良事件的危险因素.结论 RDW值对行急诊PCI术的ACS患者预后有一定价值;RDW较高患者,其住院期间及出院1年内预后较差.     

综合优质护理干预对糖尿病患者血糖控制和生活质量的影响

目的 调查分析综合优质护理干预与常规护理对糖尿病患者生活质量的影响.方法 将我科2015年5月—2016年10月入院的100例对文字内容能正确理解的糖尿病患者随机分为常规组和综合优质组,每组各50例.常规组给予常规护理干预,综合优质组给予综合优质护理干预,比较两组患者血糖恢复正常时间、平均住院时间、糖尿病知识知晓率,治疗前和治疗后患者血糖水平、生活质量的差异.结果 综合优质组患者血糖恢复正常时间、平均住院时间短于对照组,糖尿病知识知晓率高于常规组,P ＜0.05;综合优质组患者血糖水平、生活质量改善幅度有所提高,P＜0.05.结论 综合优质护理干预可有效提升患者对疾病认知,缩短血糖恢复正常和住院时间,有效降低患者血糖,提升患者生活质量,值得推广.     

尿酸对急性心肌梗死急诊PCI术后患者近期预后的影响

 目的 探讨急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的急性心肌梗死(acute myocardial infarction ,AMI)患者入院血浆尿酸(uric acid ,UA)水平对近期预后的影响。方法 400例行急诊PCI的AMI患者按血浆UA水平的75%分位数分为高UA组和低UA组,分别比较两组患者的一般临床资料、实验室和超声检查资料、冠状动脉造影资料及住院期间主要不良心脏事件(major adverse cardiac events ,MACE)的差异。采用Logistic多元回归分析对近期预后进行单因素和多因素分析,并应用Kaplan-Meier 法分析血浆UA水平对该类患者住院期间MACE发生率的影响。结果 400例中有101例在住院期间发生MACE,占25.25%;其中高UA组44例,占44.0%;低UA组57例,占19.0%。Logistic回归分析显示UA>395 μmol/L、Killip分级＞1、多支病变(≥两支冠状动脉病变)和LVEF<50%是AMI患者急诊PCI术后近期预后不良的独立预测因子。结论 AMI患者入院血浆UA水平与住院期间MACE发生率独立相关,提示高UA预后不良。
     

急性冠状动脉综合征患者血浆miR- 375水平与预后的关系

【摘要】 目的 探讨急性冠状动脉综合征（ACS）患者血浆微小核糖核酸（miR）-375水平与预后的关系。 方法 选取2016年3月至2017年4月在昆明医科大学第一附属医院接受经皮冠状动脉介入治疗（PCI）的206例ACS患者作为研究对象。采用实时荧光定量聚合酶链反应（PCR）法检测ACS患者血浆miR-375水平,分析其与患者预后的关系。 结果 PCI术后预后不良组血浆miR-375水平高于预后良好组,差异有统计学意义（P＜0.05）。低miR-375组平均生存时间高于高miR-375组,差异有显著统计学意义（P＜0.001）。Cox多因素分析结果显示,ACS家族史和miR-375是ACS预后的独立危险因素（P＜0.05）。限制性立方样条分析结果显示,血浆miR-375水平与ACS预后明显相关（P＜0.001）,且呈线性关系（非线性检验,P=0.127）。与miR-375=2.62比较,患者miR-375＞2.62时,预后不良风险增加。 结论 ACS患者PCI术后血浆miR-375水平降低。PCI术后血浆miR-375水平升高与ACS预后不良有关,是ACS预后不良的独立危险因素。     

综合护理干预在糖尿病患者临床护理中的应用研究

目的：分析综合护理干预对住院糖尿病患者血糖指标作用效果。方法将某医院从2015年2月～12月收治的114例患者随机分为干预组和对照组各57例。对照组采用常规护理模式,干预组采用综合护理干预模式。调查两组患者平均血糖水平、日间血糖平均绝对差和日内平均血糖波动幅度及两组患者糖尿病知识掌握程度。结果干预组患者平均血糖水平、日间血糖平均绝对差和日内平均血糖波动幅度指标值均低于对照组,干预组糖尿病相关知识掌握的合格程度高于对照组,差异有统计学意义（ P＜0.05）。结论综合护理干预管理,能有效提高降血糖效果,并稳定患者的血糖波动。     

个性化护理对老年糖尿病患者出院后遵医行为的影响

目的：观察个性化护理对老年糖尿病患者出院后遵医行为的影响,探讨提高老年糖尿病患者护理质量的措施。方法选择同期住院治疗的老年2型糖尿病患者84例,随机均分为对照组和观察组,对照组住院期间给予常规专科护理,观察组住院期间施行个性化护理措施,比较两组患者出院6个月后血糖指标、遵医行为评分及生活质量评分。结果出院6个月后两组患者的血糖指标、遵医行为评分及生活质量评分比较,差异均具有统计学意义（P＜0.05）,观察组均优于对照组。结论对老年住院糖尿病患者应积极施行个性化护理措施,不仅有利于患者住院期间的恢复,还有利于患者出院后血糖水平的控制与生活质量的提高。     

肥胖对无糖尿病合并症的急性冠脉综合征长期预后的影响

目的 分析肥胖因素对无糖尿病合并症的急性冠脉综合征(ACS)患者长期预后的影响。方法 将571例诊断为ACS但无糖尿病的患者纳入研究,按体重指数(BMI)等级分为体重正常组(n=189)、超重组(n=266)和肥胖组(n=116)。对所有研究对象展开平均3年的出院后随访,随访终点事件为主要不良心血管事件(MACE),包括主要终点事件(心源性死亡和非致死性心肌梗死)和因不稳定型心绞痛而再次入院治疗。结果 3年随访期间有33.6%的患者发生了MACE。随着BMI等级的增加,MACE发生率逐渐降低(P=0.031)。与体重正常组相比,肥胖组3年内发生MACE的风险更低(HR=0.58,95%CI 0.37~0.91,P=0.016);在校正多种因素后,肥胖组仍具有较低的MACE发生风险(HR=0.60,95%CI 0.39~0.94,P=0.027)。结论 在患有ACS但无糖尿病的患者中,肥胖者发生长期不良心血管事件的风险比体重正常者更低,该结果与对糖尿病患者、冠心病患者的研究结果一致。肥胖因素对患有ACS但无糖尿病患者的长期预后有保护作用。     

CPGR对糖尿病合并冠心病患者PCI术后不良事件发生的影响

目的 探讨氯吡格雷抵抗(CPGR)对冠心病合并糖尿病患者经皮冠脉介入手术(PCI)治疗后不良事件的影响.方法 回顾性分析我院2010年3月～2014年1月收治的180例冠心病合并糖尿病患者的临床资料,根据术前是否出现CPGR分为氯吡格雷抵抗组(观察组,84例)和非氯吡格雷抵抗组(对照组,96例).比较两组术前的血糖、血脂以及炎症指标;并于PCI术后随访1年,比较两组心血管不良事件的发生情况.结果 观察组的血糖和hs-CRP水平均明显高于对照组,而HDL-C水平则低于对照组(P＜0.05).观察组发生非致死性心梗、支架内血栓发生率及再住院率等均明显高于对照组(P＜0.05).结论 冠心病合并糖尿病患者存在CPGR时,可能增加PCI术后心梗、支架内血栓率等发生率.对于此类患者,应积极降血糖、血脂,对降低CPGR具有积极的意义.     

急性冠状动脉综合征患者血管内介入术后溶血磷脂酰肌醇变化及意义

【摘要】 目的 探讨急性冠状动脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）术后血清溶血磷脂酰肌醇（LPI）水平变化及意义。方法 选取2015年5月至2018年5月汉中市三二〇一医院收治的203例ACS患者作为研究对象。根据血清LPI值评估ACS患者预后的最佳截断点（1.04 μmol/L）,将患者分为高LPI组（n=46）和低LPI组（n=157）。检测患者血清LPI水平,并分析其与预后的关系。结果 血清LPI评估ACS患者预后的受试者工作特征曲线下面积（AUC）为0.851,灵敏度、特异度分别为69.44%、88.02%。高LPI组、低LPI组患者间血肌酐、肌钙蛋白I（TnI）、病变血管数、美国纽约心脏病协会（NYHA）心功能分级、糖化血红蛋白（HbA1c）、尿素氮（BUN）、左心室射血分数（LVEF）、LPI差异均有统计学意义（P＜0.05）。高LPI组主要心血管不良事件（MACE）发生率显著高于低LPI组,平均生存时间显著低于低LPI组,差异均有统计学意义（P＜0.001）。Cox单因素和多因素回归分析显示,疾病分型、慢性阻塞性肺疾病、TnI、病变血管数、LPI与ACS患者预后密切相关。 结论 血清LPI与ACS患者预后密切相关。LPI水平检测有助于评估患者预后。     

急性冠脉综合征患者血清肝细胞生长因子的测定及临床意义

目的:探讨急性冠脉综合征(ACS)患者血清肝细胞生长因子(HGF)水平变化的临床意义。方法:160例住院患者分为急性心肌梗死(AMI)、不稳定型心绞痛(UA)、稳定型心绞痛(SA)及对照组(C),检测各组血清HGF水平。随访ACS患者5年内不良心血管事件的发生情况。结果:ACS患者早期血清HGF水平明显升高,发生不良心血管事件者血清HGF水平与未发生者有显著差异。结论:血清HGF浓度对ACS的早期诊断、危险分层及预后均有重要意义。     

冠心病患者血清葡萄糖和果糖胺测定的临床应用

目的探讨冠心病患者高血糖和果糖胺之间的关系。方法测定35例冠心病合并糖尿病患者和38例无糖尿病的冠心病患者的血清葡萄糖和果糖胺浓度。结果冠心病合并糖尿病组及无糖尿病的冠心病组的血糖水平分别为（9.58±1.30）mmol/L、（5.16±0.60）mmol/L,都明显高于正常对照组（4.78±0.55）mmol/L,P〈0.05。冠心病合并糖尿病组果糖胺（280±62）μmol/L,显著高于正常对照组果糖胺（180±35）μmol/L,P〈0.05,糖尿病组与无糖尿病组患者的果糖胺水平比较有显著差异（P〈0.05）,但无糖尿病冠心病组果糖胺水平（180±68）μmol/L与正常对照组比较却无显著差异（P〉0.05）。结论联合检测血糖与果糖胺对冠心病患者血糖增高的原因有鉴别价值。     

Association of ischemia on stress (99m)Tc-tetrofosmin myocardial perfusion imaging with all-cause mortality in patients with diabetes mellitus.

Stress myocardial perfusion imaging is a useful method for evaluation of coronary artery disease (CAD) in patients with diabetes mellitus. However, its role in predicting all-cause mortality is not well defined. The aim of this study was to determine whether myocardial ischemia on stress myocardial perfusion imaging can predict all causes of death in patients with diabetes mellitus. METHODS: We studied 297 patients with diabetes mellitus and known or suspected CAD by exercise or dobutamine stress (99m)Tc-tetrofosmin myocardial perfusion tomographic imaging. Ischemia was defined as reversible perfusion abnormalities. The endpoints were death from any cause and hard cardiac events (cardiac death and nonfatal myocardial infarction). RESULTS: An abnormal scan was detected in 179 (60%) patients. Myocardial perfusion abnormalities were fixed in 76 (26%) patients and were reversible in 103 (35%) patients. During a mean follow-up of 6 +/- 2.1 y, 80 (27%) patients died. Nonfatal myocardial infarction occurred in 14 (5%) patients. The annual mortality rate was 2.5% in patients with normal perfusion, 4.5% in patients with fixed defects, and 6% in patients with ischemia. The annual cardiac death rate was 4.2% in patients with ischemia and 2.6% in patients with fixed defects. In patients with normal perfusion, the annual cardiac death rate was 0.9% during the 5 y after the stress test. In a Cox multivariate analysis model, predictors of death were age, history of heart failure, peripheral vascular disease, and reversible perfusion defects. CONCLUSION: Myocardial ischemia on stress (99m)Tc-tetrofosmin myocardial perfusion imaging is associated with an increased risk of all-cause mortality during long-term follow-up among patients with diabetes mellitus. Patients with normal perfusion have a lower mortality rate and may require less frequent follow-up stress perfusion imaging.     

Use of continuous subcutaneous insulin infusion by a portable insulin pump during pregnancy in women with type 1 diabetes mellitus

BACKGROUND/AIM: Diabetes mellitus is associated with an increased risk for neonatal morbidity and mortality. One of the most important goals in treating pregnancies complicated with diabetes is keeping glucose level within the normal range, especially in the first trimester. A portable insulin pump for continuous subcutaneous insulin infusion (CSII) represents the best form of therapy for patients with type 1 diabetes mellitus during pregnancy. The aim of our study was to evaluate the effects of therapy with a portable insulin pump for continuous subcutaneous insulin infusion during the first trimester of pregnancy on the quality of glycoregulation and pregnancy outcome in women with type 1 diabetes mellitus. METHODS: A total of 17 newly diagnosed pregnant women with type 1 diabetes mellitus were treated with CSII therapy for three months. The parameters of glycoregulation (hemoglobin A, glycosylated--HbAlc, mean blood glucose value in daily profiles--MBG, daily requirement for insulin--IJ/kg BM), lipid levels, blood preassure and renal function were estimated before and after the therapy. These parameters were correlated with parameters of pregnancy outcome: fetal weight, APGAR score, duration of pregnancy. RESULTS: There was a significant improvement in HbA1c (8.94 +/- 1.62 vs. 6.90 +/- 1.22 %,p < 0.05), MBG (9.23 +/- 2.22 vs. 6.41 +/- 1.72 mmol/l, p < 0.01), and daily requirement for insulin (0.66 +/- 0.22 vs. 0.55 +/- 0.13 IJ/kg BM, p < 0.05) during the CSII therapy. There were significant correlations between fetal weight and HbAlc (r = -0.60, p < 0.05), triglyceride levels (r = -0.63, p < 0.01), and the number of pregnancies (r = -0.62, p < 0.01), as well as between APGAR score and MBG (r = -0.52, p < 0.05) and cholesterol levels (r = -0.65, p < 0,01) before a portable insulin pump was applicated. CONCLUSIONS: There was a significant improvement in the quality of glycoregulation during CSII therapy in the pregnant women with type 1 diabetes mellitus. The quality of glycoregulation in the moment of conception was the important factor for pregnancy outcome.     

Variability of insulin-stimulated myocardial glucose uptake in healthy elderly subjects

The aim of this study was to assess regional and global variability of insulin-stimulated myocardial glucose uptake in healthy elderly subjects and to evaluate potentially responsible factors. Twenty men with a mean age of 64 years, no history of cardiovascular disease, and normal blood pressure, bicycle exercise test, electrocardiogram and echocardiography were studied [ P(coronary artery disease) <5%]. Whole-body insulin sensitivity and insulin-stimulated myocardial glucose uptake were measured during hyperinsulinaemic euglycaemic glucose clamp with fluorine-18 fluorodeoxyglucose, and myocardial rest and hyperaemic blood flow during dipyridamole infusion were measured with nitrogen-13 ammonia and positron emission tomography in 16 left ventricular myocardial segments. Intra-individual and inter-individual variability of insulin-stimulated myocardial glucose uptake [relative dispersion = (standard deviation/mean)] was 13% and 29% respectively. Although inter-individual variability of glucose uptake and blood flow at rest was of the same magnitude, no correlation was found between these measures. Regional and global insulin-stimulated myocardial glucose uptake correlated linearly with whole-body insulin sensitivity ( r=0.51, P<0.05 and r=0.56, P<0.01). The strongest independent association by multivariate linear regression analysis was found between myocardial glucose uptake and hyperaemic blood flow ( r=0.63, P<0.005). We conclude that in healthy elderly subjects, insulin-stimulated myocardial glucose uptake is homogeneous throughout the left ventricle, but has moderate inter-individual variability. Inter-individual variability of insulin-stimulated myocardial glucose uptake is primarily explained by variability in coronary vascular reactivity and tissue insulin sensitivity.     

Glucose and insulin variations in patients during the time course of a FDG-PET study and implications for the "glucose-corrected" SUV

INTRODUCTION: 2-Deoxy-2[(18)F]fluoro-d-glucose (FDG) positron emission tomography (PET) has an established role in the evaluation of cancer. Generally, tumor uptake and response to treatment are evaluated using the standardized uptake value (SUV). Some authors have proposed correcting SUV for glucose levels. Insulin is also thought to influence tumor uptake by changing uptake in other tissues. However, little attention has been paid to understanding the variability of glucose or insulin during a single PET study. METHOD: We studied the biological and instrumental variability of glucose and insulin measurements in 71 nondiabetic patients undergoing FDG-PET studies. Multiple glucose measurements were obtained in all 71 subjects, and in 69 of these 71 subjects, multiple serum insulin measurements were made. We determined the coefficient of observed variation (CV(ow)) and the coefficient of variation attributable to biological variability (CV(bv)) for both glucose and insulin. RESULTS: The mean glucose concentration was 78.9+/-13.5 mg/dl. The mean insulin value was 6.49+/-5.92 microU/ml. The weighted mean CV(ow) and CV(bv) was 5.0% and 3.6%, respectively, for glucose and 14.2% and 8.3%, respectively, for insulin. CONCLUSIONS: Variations in the range of 3.6% are observed in glucose measurements during the time course of an FDG scan even after accounting for analytical error; larger variations of 8.3% are observed in insulin levels. Therefore, corrections of SUV for blood glucose, especially if obtained from single measurements, can introduce additional errors of at least this much.     

2型糖尿病患者血糖波动与抑郁状态的相关性

 目的 探讨2型糖尿病(type 2 diabetes mellitus,T₂DM)患者血糖波动情况与抑郁状态的相关性。方法 选取2015-08至2016-09就诊医院内分泌科T₂DM患者42例为T₂DM组,选择年龄、性别相匹配的健康志愿者28名为对照组,对所有患者进行连续72 h动态血糖监测(continuous glucose monitoring system,CGMS);均行蒙哥马利抑郁评定量表(Montgomery and Asberg depression rating scale,MADRS)评分。比较两组MADRS评分、血糖波动参数,并分析T₂DM组血糖波动参数与MADRS的相关性。结果 T₂DM组MADRS评分为(15.67±7.43)分,对照组MADRS评分为(8.29±3.76)分,T₂DM组高于对照组,差异有统计学意义(t=4.818,P<0.01)。T₂DM组与对照组相比,平均血糖波动幅度(mean amplitude of plasma glucose excursions,MAGE)、全天血糖水平标准差(standard deviation of blood glucose,SDBG)、最大血糖波动幅度(largest amplitude of plasma glucose excursions, LAGE)、日间血糖平均绝对差(means of daily differences, MODD)、平均餐后血糖波动幅度(mean amplitude of plasma postprandial blood Glucose excursions, MPPGE)均明显升高,差异有统计学意义(P<0.01)。T₂DM患者MAGE与MADRS评分呈正相关(r=0.330,P<0.05)。结论 MAGE与抑郁的发生有关。     

化疗对恶性肿瘤患者血糖代谢的影响

目的探讨化疗对恶性肿瘤患者血糖代谢的影响。方法对化疗前血糖水平正常的105例恶性肿瘤患者,追踪其化疗结束后的血糖检验报告及相关临床资料,并进行回顾性分析。结果①化疗后空腹血糖升高19例,占18.09%（19/105）。其中明确诊断为糖尿病者4例,占3.81%（4/105）;糖耐量减低6例,占5.71%（6/105）;一过性血糖异常升高9例,占8.57%（9/105）。②化疗诱发的血糖异常多发生在化疗的第1~3个疗程。③以紫杉醇合并铂类化疗后血糖升高为著（20%）。④不同肿瘤化疗后血糖异常升高发生率无差异（P〉0.05）。结论恶性肿瘤患者接受化学药物治疗后可能会出现血糖异常,甚至发生糖耐量减低或糖尿病,尤以紫杉醇合并铂类化疗影响为著,应引起重视。     

肝脓肿经皮穿刺引流术的疗效及影响因素分析

目的 观察经皮穿刺引流对肝脓肿的治疗效果,分析影响疗效的因素,探讨降低病死率、并发症率,缩短住院时间的方法.方法 收集2011年1月至2016年1月收治的121例肝脓肿患者临床资料.对确诊肝脓肿患者,充分抗感染治疗的同时,CT评估病灶液化情况,在CT引导下行经皮肝穿刺引流,分析治疗后的病死率、并发症率、住院时间及其影响因素.结果 共有121例肝脓肿患者纳入研究.2例患者穿刺引流后死亡,病死率为1.6％,影响患者死亡率的因素为高龄、基础疾病,脓肿直径及实性成分;2例患者穿刺引流后出现肝周脓肿、腹壁脓肿,并发症率为1.6％,对并发症积极处理后达到临床治愈,影响并发症率的因素主要为手术操作欠妥;119例患者均达到临床治愈,治愈率为98.3％,平均住院时间为(15.1±6.0)d.影响住院时间的危险因素为:脓肿个数X6(r=0.232,P=0.021),脓肿大小X7(r=0.26,P=0.005),白细胞计数X8(r=0.238,P=0.009).进一步分析显示影响因素与住院时间相关性的多元线性回归方程有统计学意义(P＜0.05),多元回归方程为:Y=-3.438+3.055X6+0.527X7+0.297X8,F=5.819,R2=0.416.性别、年龄、糖尿病、致病原菌种类、脓肿位置对住院时间的影响无统计学差异(P＞0.05).结论 经皮穿刺肝脓肿引流术是治疗肝脓肿的有效方法,具有病死率低,并发症率低、住院时间短的特点.     

急性冠脉综合征合并心源性休克术后伴发认知功能障碍的影响因素

 目的 探讨急性冠脉综合征(acute coronary syndromes, ACS)合并心源性休克(cardiac shock, CS)患者各项潜在影响因素与伴发经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)术后认知功能障碍(post-operative cognitive dysfunction, POCD)的相关性。方法 选择医院2014-07至2016-01收治的ACS合并CS患者为研究对象。登记患者的一般情况、既往史、个人史等基线资料;统计急性生理与慢性健康评分(acute physiology and chronic health evaluation Ⅱ, APACHEⅡ)、主动脉内球囊反搏术(intra-aortic balloon pump, IABP)指标等。以ACS合并CS患者是否于入院1周内伴发POCD为因变量,上述影响因素为协变量,通过组间比较及二分类logistic回归分析患者伴发POCD的独立影响因素。结果 最终纳入48例ACS合并CS患者。其中18例于相应时间窗内伴发POCD,30例未见认知功能异常。两组患者干预措施具有可比性,除年龄及学历构成之外,其余基线资料均具有可比性。logistics回归显示:年龄、血清神经元特异性烯醇化酶(neuron-specific enolase, NSE)、学历构成、胸痛至开通血管时间、使用IABP、降低反搏频率时血压骤降、使用右美托咪啶进入回归模型(P＜0.05)。其中学历构成、使用IABP、使用右美托咪啶为独立保护因素;年龄、NSE、胸痛至开通血管时间、降低反搏频率时血压骤降为独立危险因素。结论 年龄、NSE、胸痛至开通血管时间、降低反搏频率时血压骤降为PCI后POCD的独立危险因素。     

高血糖合并隐匿性冠心病患者的冠状动脉CT血管成像研究

目的在2型糖尿病(DM)及糖调节受损(IGR)隐匿性冠心病患者中进行64层CT冠状动脉成像研究,明确64层CT对高血糖合并隐匿性冠心病患者冠状动脉病变的诊断价值。方法选取2009年4月至2011年6月山西省人民医院内分泌科门诊及住院患者120例,包括DM53例和IGR 67例,所有患者均完成一般体格检查、血糖、血脂、血压及64层CT冠状动脉成像检查。血管阻塞面积大于等于50%者推荐行冠状动脉腔内成形(PCI)术。结果所有患者中38例(31.7%)存在显著的冠状动脉狭窄,其中DM患者25例(47.2%),IGR患者13例(19.4%),二者之间存在显著差异(P<0.01)。DM者较IGR者不仅冠脉狭窄、钙化斑块的发生率显著升高(50.8%vs 27.4%,P<0.05),而且发生多支病变者也显著增多,但二者间软斑块的发生率无显著性差异。结论 64层CT冠状动脉成像检查作为一项无创的检查方法,不仅能够有效分辨冠状动脉硬化的程度,而且能够区分斑块的类型,对于指导DM及IGR合并隐匿性冠心病患者下一步进行冠心病阻断治疗或进行冠脉血运重建具有重要意义。