冠心病合并2型糖尿病患者临床和冠脉造影特点分析

目的探讨冠心病（CHD）合并2型糖尿病（DM）患者的临床和冠脉造影特点。方法选择经冠脉造影证实的冠心病患者515例，根据是否合并糖尿病将其分为糖尿病组（353例）和非糖尿病组（162例），比较两组患者的临床和冠脉造影资料。结果合并2型糖尿病的冠心病患者发生高血压和急性心肌梗死的比例明显高于非糖尿病的冠心病患者（P〈0．01），前者血甘油三酯水平也明显高于后者（P〈0．01）。冠心病合并2型糖尿病患者多发生多支病变，左主干病变也明显高于非糖尿病者（P〈0．01）。结论冠心病合并2型糖尿病患者临床和冠脉病变复杂。     

2型糖尿病合并冠心病患者尿微量白蛋白与冠脉病变程度的关系

目的通过对2型糖尿病合并冠心病患者尿微量白蛋白水平与冠状动脉造影结果的相关研究,分析尿微量白蛋白与冠状动脉病变程度的相关性。方法患有2型糖尿病的冠状动脉造影患者98例,根据冠状动脉造影结果分为冠心病组与对照组,测定其尿微量白蛋白水平。结果冠心病组与对照组相比,尿微量白蛋白明显升高,差异有统计学意义（P〈0．01）;单支、双支、三支病变组与对照组相比差异均有统计学意义（P〈0．01）;且三支病变组与单支、双支病变组比较,差异有统计学意义（P〈0．05）。结论尿微量白蛋白与冠状动脉病变严重程度呈正相关,微量白蛋白尿是冠心病的独立危险因素之一。     

冠心病合并糖调节异常患者冠脉病变特点及预后观察

目的：观察冠心病合并糖调节异常患者冠脉病变的特点及预后。方法：选择经冠脉造影确诊为冠心病105例,根据血糖情况分为糖耐量正常组（NGT组）30例、糖耐量异常组（IGT组）30例和糖尿病组（DM组）45例。观察3组冠脉病变的特点及心血管不良事件发生率。结果：DM组I、GT组冠脉多支病变率、冠脉末梢病变发生率均显著高于NGT组（P〈0.05）,DM组与IGT组心血管不良事件发生率显著高于NGT组（P〈0.05）。结论：合并糖调节异常的冠心病患者,冠脉病变广泛、严重,且心血管不良事件发生率高,应加强对心血管患者的血糖检测。     

药物洗脱支架治疗2型糖尿病合并冠心病多支血管病变的中期疗效

目的对比分析裸金属支架（BMS）与药物洗脱支架（DES）在2型糖尿病（T2DM）合并多支冠脉病变经皮冠状动脉介入治疗（PCI）应用中的安全性和中期疗效,为DES治疗此类患者提供依据。方法连续人选2002年11月-2005年6月首次接受PCI治疗的443例T2DM合并多支冠脉血管病变患者,其中BMS组226例,雷帕霉素（Cypher）支架组91例,紫杉醇（TAXUS）支架组126例,分析患者住院期间及随访6个月的临床情况。结果三组患者临床特征、手术成功率及住院期间主要不良心脏事件（MACE）发生率等指标均无明显差异。Cypher支架组中病变长度和分叉病变的比例及TAXUS支架组中3支血管和分叉病变的比例均明显高于BMS组（P〈0．05或0．01）。两DES组的造影随访再狭窄率明显低于BMS组（Cypher组3．2％、TAXUS组4．5％协BMS组37．3％,P〈0．05）,临床随访6个月MACE发生率亦明显低于BMS组（Cypher组5．7％、TAXUS组5．8％wBMS组18．5％,P〈0．01）。结论与BMS相比,T2DM合并多支冠脉血管病变患者植入Cypher支架和TAXUS支架安全性高,6个月中期疗效较理想。     

血尿酸、白细胞水平与冠状动脉病变的关系

目的探讨血清尿酸（Uric acid,UA）、白细胞（WBC）水平与冠心病患者冠状动脉病变之间的关系。方法选择2011年4月～2012年4月在我院住院的疑似冠心病患者228例。根据冠脉造影结果分为冠心病组155例和正常组73例,冠心病组又分为3个亚组：单支病变组82例,双支病变组46例,三支病变组27例。分别测定冠心病组、正常组血清UA及WBC水平,观察其与冠状动脉病变的关系。结果冠心病组尿酸、白细胞水平均高于正常组,差异具有统计学意义（P〈0．05）;冠心病亚组中,随着血尿酸水平的增加,冠状动脉病变程度亦加重,差异具有统计学意义（P〈0．05）;3组间白细胞水平未见明显差异（P〉0．05）。结论血尿酸水平的升高可能与冠脉病变的程度相关;白细胞水平可能与冠心病的发生有关,但与冠脉病变的程度无关。     

糖化血红蛋白与冠状动脉病变程度关系的探讨

目的探讨冠心病患者糖化血红蛋白水平与冠状动脉病变程度之间的关系。方法冠状动脉造影住院患者209例,经造影确诊冠心病164例（占78．5％）,排除冠心病患者45例（占21．5％）。冠状动脉病变程度以冠状动脉病变的支数表示,分为正常对照组、冠状动脉单支血管病变组、冠状动脉多支血管病变组。所有研究对象检测糖化血红蛋白（HbA1C）、血脂。结果冠状动脉多支血管病变组HbA1c水平（6．65±1．44）％,冠状动脉单支病变组（6．18±1．16）％,冠脉造影正常组HbA1c水平（6．06±1．05）％。冠脉多支血管病变组HbA1C水平较单支病变组及正常对照组高,差异有统计学意义（P〈0．05）,冠脉单支病变组HbA1c与冠脉造影正常组比较无显著差异。结论血清HbA1C水平对判断冠状动脉病变程度有一定的价值。     

内皮型一氧化氮合酶基因Glu-298Asp多态性与冠心病及冠脉狭窄程度的关系

目的：探讨冠心病（coronary heart disease,CHD）患者内皮型一氧化氮合酶（endothelial nitric oxide synthase,eNOS）基因多态性与CHD及冠状动脉狭窄程度之间的关系。方法：收集2006年1月～2007年1月在我院行冠状动脉造影的病例,PCR检测eNOS基因谷氨酸一天门冬氨酸（Glu-298Asp）多态性,计算冠脉造影积分,比较不同eNOS基因型与CHD及冠状动脉病变狭窄程度之间的关系。结果：eNOS基因Glu--298Asp多态性在80例CHD患者中,TT基因型15例（0．19）,TG基因型21例（0．26）,GG基因型44例（0．55）;与对照组比较,TT和TG基因型的构成比有增加趋势。CHD组的T等位基因频率为0．32,G等位基因频率为0．68,CHD组的T等位基因频率显著高于对照组（P〈0．05）。CHD组不同基因型患者病变冠脉积分和冠脉病变积分差异显著。结论：在研究对象中,eNOS基因Glu-298Asp多态性与CHD及冠状动脉狭窄程度相关。     

脂蛋白脂酶基因多态性与冠心病和血脂关系的研究

目的：通过研究脂蛋白脂酶（LPL）基因与冠心病（CHD）和血脂的关系，探讨冠心病的遗传易感因素。方法：选择经冠脉造影确诊的冠心病患者80例，对照组60例。LPL基因多态性通过聚合酶链反应-限制性片段长度多态性法测定。结果：CHD组中LPL基因突变型SX和XX者HDL-C水平高于SS基因型者，差异有统计学意义（P〈0．05）；LPL基因型分布和等位基因频率在CHD组和对照组间差异无统计学意义（P〉0．05）。结论：LPL基因与冠心病发病无相关性，但LPL基因突变可致HDL-C升高，可能对冠心病产生有益影响。     

血清游离脂肪酸与2型糖尿病微血管病变的关系

目的：研究2型糖尿病微血管病变患者血清游离脂肪酸（FFA）的变化。方法：2型糖尿病（DM）组40例,根据是否合并微血管病变分为单纯DM组20例,微血管病变组（糖尿病视网膜病变10例,糖尿病肾脏病变10例）20例,选择20例同期健康体检者作为正常对照组。采用比色法测定血清FFA水平。结果：糖尿病微血管病变组血清FFA的水平高于单纯DM组（P〈0．05）;单纯DM组血清FFA的水平显著高于正常组（P〈0．01）。结论：2型糖尿病微血管病变患者血清FFA水平升高,FFA可能参与了糖尿病微血管病变的发生、发展。     

西宁地区急性ST段抬高心肌梗死与非ST抬高心肌梗死临床基本特征和冠状动脉病变特点比较

分析西宁地区急性sT段抬高心肌梗死（STEMI）与非sT抬高心肌梗死（NSTEMI）临床基本特征和冠状动脉病变特点。方法：对明确诊断的143例西宁地区STEMI、48例NSTEMI的两组患者进行临床基本特征、心肌损害指标、心功能及冠脉造影进行比较。结果．（1）STEMI组心肌梗死病史、心绞痛史、糖尿病比例发生率均低于NSTEMI组（P〈0．05）,两组中海拔〉3000m发病情况无统计学意义（P〉0．05）;（2）STEMI组患者发生恶性心律失常、心力衰竭的比例高于NTEMI组（P〈0．05）;③STE—MI组肌钙蛋白T、肌酸磷酸激酶同工酶水平均明显高于NSTEMI组（P〈0．05）,超声心动图检查指标两组差异无统计学意义（P〉0．05）;④NSTEMI组患者三支病变及〈90％的狭窄低于STEMI组,侧支循环形成丰富。结论：NSTEMI较STEMI合并糖尿病比例相对较高,既往多有心肌梗死病史和心绞痛症状,并发恶性心律失常、心力衰竭的比例以及血中心肌损伤标记物较低,冠脉病变弥漫、累及多支,形成侧支循环的比例高,其发病前常存在缺血预适应,这是心肌梗死形成非ST段抬高的主要原因,对于STE—MI、NSTEMI的患者我们可以按平原地区的标准进行诊断、评价及判断顸后。     

2型糖尿病患者冠心病冠脉造影与心电图特点分析

目的:探讨2型糖尿病患者冠心病冠脉造影及心电图特点。方法:203例患者按照冠心病的临床分类分为心梗组与非心梗组,对冠脉造影及心电图结果进行分析。结果:心梗组患者冠脉造影狭窄血管总数明显高于非心梗组(62.8%对53.3%,P<0.01),且三支血管病变多(50.0%对26.5%,P<0.01),病变血管完全闭塞比例高(23.0%对12.4%,P<0.01);而单支血管病变(14.4%对28.3%,P<0.05)和血管狭窄程度<50%的比例(4.9%对14.1%,P<0.01)均低于非心梗组。两组之间的狭窄病变分布部位,弥漫受累血管总数,弥漫病变分布部位及各分支弥漫受累比例差异均无统计学意义。心电图分析结果示心梗组的病理性Q波出现率明显高于非心梗组(67.8%8%对19.5%,P<0.01)且T波倒置多(74.4%对59.3%,P<0.05)而ST段改变两组差异无显著性意义(43.3%对46.9%,P>0.01)。结论:2型糖尿病冠心病在冠脉造影上心梗组较非心梗组冠状动脉狭窄病变支数多及其狭窄程度严重,病变的分布部位及弥漫性受累血管总数差异不显著。心电图是2型糖尿病冠心病的一种简单有效的筛选方法,但存在一定的假阳性率和假阴性率。     

2型糖尿病合并急性心肌梗死患者心肌灌注显像及冠脉造影特点分析

目的 探讨2型糖尿病（2DM）合并急性心肌梗死患者的心肌灌注断层显 像和冠状动脉病变的特征性改变。方法 25例2DM合并急性心肌梗死患者,随机选取同期住院的单纯冠心病急性心肌梗死患者10例作为对照。所有患者均行核素心肌灌注显像（静态和硝酸甘油介入心肌断层显像）及冠状动脉造影。结果 25例2DM合并心肌梗死者冠状动脉造影3支病变占60％,明显高于对照组（40%);拟肌灌注检出的放射性缺损节段数为32．25％（129／400）,而对照组为15．62％（25／160）。结论 2DM合并急性心肌梗死患者呈广泛多节段灌注缺损,冠状动脉多为多支病变,重度狭窄。     

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。     

2型糖尿病患者64层螺旋CT冠状动脉造影表现的研究

目的:评价64层螺旋CT冠状动脉造影检测2型糖尿病患者冠脉病变程度、冠脉内斑块性质的价值;评估2型糖尿病患者冠状动脉病变发生的危险性。方法:收集200例患者(糖尿病组100例,非糖尿病组100例)64层螺旋CT冠状动脉成像资料,并根据糖尿病患者发病年限将2型糖尿病组分成3组:0~6年、6~14年、>14年,对冠状动脉狭窄程度及斑块性质进行评价。结果:2型糖尿病组血管病变支数明显多于非2型糖尿病组(P<0.01),2型糖尿病组单支病变明显少于非糖尿病组(P<0.05);糖尿病组三支病变发生率为36.9%,而非糖尿病组发生率为33.5%,两组比较差异有统计学意义(P<0.05)。2型糖尿病组重度狭窄病变明显多于非糖尿病组(P<0.05)。研究显示:0~6年组冠脉病变以纤维斑块为主,管腔以轻中、度狭窄为主;6~14年组病变以纤维斑块和混合斑块为主,管腔呈中、重度狭窄;>14年组病变以弥漫钙化为主,管腔呈中、重度狭窄。Logistic分析表明2型糖尿病与冠状动脉病变密切相关。结论:2型糖尿病患者有高度的冠状动脉病变危险性,且随患病年限延长病变加重。64层螺旋CT是糖尿病患者诊断冠状动脉病变可靠的、无创的检查方法,可有效检测糖尿病患者冠状动脉病变的程度和冠脉斑块性质,对冠心病诊断和临床评估冠心病风险具有重要价值。     

Detection of coronary artery disease by stress thallium scintigraphy in diabetic patients

We investigated the efficacy of exercise stress thallium in the diagnosis of coronary artery disease in patients with diabetes mellitus. Forty-three patients with known diabetes and suspected of having coronary artery disease were included in the study. All the patients underwent coronary angiography, 24 had significant coronary artery stenosis and 19 had normal coronaries. Out of the 24 patients with a positive angiographic finding, thallium scintigraphy was positive in 21 patients (sensitivity, 87.5%); and false negative in only three of the 24 patients. Out of the 19 patients with normal angiography findings, 16 patients had a normal thallium scan (specificity, 84.2%) and the remaining three had a positive thallium scan. This gives thallium scintigraphy a positive predictive value of 87.5% and negative predictive value of 84.2% when compared with coronary angiography. The findings of this study suggest that stress thallium scintigraphy is a useful modality in screening of coronary artery disease in diabetic patients.     

Different manifestations of coronary artery disease by stress SPECT myocardial perfusion imaging,coronary calcium scoring,and multislice CT coronary angiography in asymptomatic patients with type 2 diabetes mellitus

Background. We sought to assess prospectively the evidence for silent coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes mellitus by stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging, coronary artery calcium (CAC) scoring, and multislice computed tomographic (MSCT) coronary angiography. Methods. One hundred asymptomatic patients (aged 30 to 72 years) with type 2 diabetes mellitus and one or more risk factors for CAD were prospectively recruited from an outpatient diabetes clinic. All patients underwent adenosine technetium-99m sestamibi SPECT imaging, CAC scoring, and 64-slice MSCT coronary angiography. Results. Twenty-three patients (23%) had abnormal stress SPECT imaging, consistent with inducible myocardial ischemia, whereas 60 patients (60%) had positive CAC scoring (18 patients [18%] with significant CAC >401), and 70 patients (70%) had abnormal MSCT coronary angiography (24 patients [24%] with significant, ≥50% stenosis). Of 77 patients with normal SPECT, 44 had a positive CAC score (10 patients [13%] >401), and 54 showed CAD on MSCT angiography (16 patients [21%] with ≥50% stenosis). Of 23 patients with an abnormal SPECT, 16 patients had a positive CAC score (8 patients [35%] >401), and 16 patients had CAD on MSCT angiography (8 patients [35%] with ≥50% stenosis). Overall, 17 patients (17%) had more than 2 significantly abnormal diagnostic test results, and 5 patients had three tests with significantly abnormal results. Conclusions. In this cohort of asymptomatic patients with type 2 diabetes mellitus, different modalities visualized different aspects of silent coronary atherosclerosis. Anatomic evidence of coronary atherosclerosis (CAC and MSCT) occurred more frequently than functional evidence (stress SPECT). However, clinically significant manifestations of CAD were observed in about one-quarter to one-fifth of patients by each modality, either separately or combined. The relative prognostic value of each modality needs to be determined by a follow-up of this cohort. This work was supported by an unrestricted grant from BMS Medical Imaging. In addition, J.J.B. has received research grants from GE Healthcare.     

Role of 320-slice multislice computed tomography coronary angiography in the assessment of coronary artery stenosis

Objective

To evaluate the effectiveness of the multislice CT coronary angiography, as a non-invasive imaging tool in assessment of coronary artery stenosis.

Patients and methods

The study included 50 patients who were referred for MSCT coronary angiography followed by catheter coronary angiography. Patients with previous coronary bypass grafts and those with coronary stents were excluded. History of contrast allergy, renal impairment and severe chest conditions were exclusion criteria. The coronary angiographic CT studies were performed using a 320 CT scanner. The catheter coronary angiographic studies were performed via femoral arterial puncture. The results of CT angiography were compared with the gold standard catheter angiography.

Results

The positive predictive value and negative predictive value of MSCT coronary angiography in detection of coronary artery stenosis were 94% and 100%, respectively.

Conclusion

In conclusion, MSCT coronary angiography is a very helpful and rapid non-invasive coronary imaging modality that was able to detect and grade coronary artery stenosis better than other noninvasive examinations used to detect CAD, such as exercise stress testing. Due to its very high negative predictive value, it may eliminate the need for invasive coronary procedures in the presence of normal coronary imaging.