64层双源螺旋CT结合血清学标志物评价老年2型糖尿病合并冠心病患者冠脉斑块的稳定性

目的 应用64层双源螺旋CT冠状动脉成像（dual-source CT,DSCT）检查方法评价老年糖尿病合并冠心病患者冠脉斑块性质,同时分析老年糖尿病合并冠心病患者血清学标志物的变化,为预测急性冠脉事件风险、早期识别易损斑块患者提供诊断依据.方法 选取2010年12月至2013年10月期间在昆明医科大学附属延安医院老年科和心内科住院,临床疑诊冠心病的老年患者,经行64层双源螺旋CT检查、冠脉造影检查诊断明确为冠心病共129例,根据有无2型糖尿病（T2DM）病史分为：老年冠心病组（n=69）和老年T2DM合并冠心病组（n=60）.采用酶联免疫法测定C反应蛋白（CRP）、血浆粘附分子-1（VCAM1）、基质金属蛋白酶9（MMP-9）、白细胞介素6（IL-6）和同型半胱氨酸（Hcy）.评价64-DSCT对老年冠心病患者冠脉斑块性质及血清学标志物等方面的差异.结果 老年T2DM合并冠心病与老年冠心病组比较冠脉斑块构成有差别,老年T2DM合并冠心病组软斑较老年冠心病组所占比例高（P＜0.05）.老年T2DM合并冠心病组IL-6、VCAM1、MMP-9、Hcy表达均高于老年冠心病组,非钙化斑块组血清学标志物CRP、IL-6、VCAM1、Hcv比钙化斑块组高,2组间比较差异均有统计学意义（P＜0.05）.结论 64-DSCT能够对冠状动脉粥样斑块进行初步定性分析,老年糖尿病合并冠心病患者冠脉斑块以软斑和混合斑为主,血清学标志物CRP、IL-6、VCAM1、Hcv可作为预测斑块稳定性的指标.

Evaluation the Stability of Coronary Plaque by Combining 64-section Dual Source CT with Inflammatory Mediators in Aged Type 2 Diabetics with Coronary Artery Disease

Objective To evaluate the vascular lesion of corouary artery by 64-section Dual source CT and analyze inflammatory mediators in aged type 2 diabetes mellitus （T2DM） with coronary heart disease （CHD）,which can provide the diagnosis evidence for predicting the risk of coronary heart disease and the early identification of vulnerable patients.Methods Subjects were divided into two groups,there were 69 cases in elderly CHD group,60 cases in elderly T2DM with CHD group.The vascular lesion of coronary artery was analyzed by 64-section Dual source CT.Meanwhile,the levers of creactive protein （CRP）,Plasma adhesion molecule-1 （VCAM1）,matrix metalloproteinases 9 （MMP-9）,interleukin 6 （IIL-6） and homocysteine （Hcy） were measured by ELISA.Results Compared with the elderly CHD group,the proportion of soft plaque was higher in elderly T2DM with CHD group,the difference was statistically significant （P＜0.05）.The levels of IL-6,VCAM1,MMP-9 and Hcy in elderly T2DM with CHD group were higher than elderly CHD group.The levels of CRP,IL-6,VCAM1 and Hcv in the patients with non-calcified plaque were higher than the patients with calcific plaque,the difference was statistically significant （P ＜0.05） Conclusion The 64-section Dual source CT coronary angiography can effectively detect coronary plaque composition.The composition of coronary plaque in elderly T2DM with CHD group are mainly soft plaque and mixed plaque.The serological markers of CRP,IL-6,VCAM1,Hey can be used as a prediction index of plaque stability.