老年冠心病合并2型糖尿病患者冠状动脉造影结果分析

目的探讨合并2型糖尿病的老年冠心病患者冠状动脉造影的特点。方法 50例老年冠心病合并2型糖尿病患者（糖尿病组）与50例老年冠心病未合并2型糖尿病患者（对照组）,均行冠状动脉造影检查,并进行比较。结果糖尿病组冠状动脉造影主要表现为多支病变和多支多节段病变,对照组主要表现为单支病变和2支单节段病变;糖尿病组单支病变、多支病变、弥漫性狭窄病变、重度及闭塞病变发生率分别为14%,58%,78%和88%;对照组分别为44%,26%,20%和40%,2组比较差异均有统计学意义（P〈0.05）。结论老年冠心病合并2型糖尿病者冠状动脉的狭窄程度较未合并2型糖尿病者重。     

Cardiovascular disease and type 2 diabetes mellitus: A multifaceted symbiosis

Chronic hyperglycaemia (e.g. type 2 diabetes mellitus (T2DM) and prediabetes) in humans is associated with an increased risk of cardiovascular (CV) complications, and, vice versa, the presence of CV complications (e.g. myocardial infarction, stroke or intermittent claudication) among patients heightens the risk of T2DM or prediabetes. In both cases (i.e. chronic hyperglycaemia and CV complications), significant diagnostic and treatment challenges resulting from a broad range of factors may serve as barriers to reducing the deleterious societal impact of T2DM and prediabetes. These challenges often include clinicians: failing to intervene early and aggressively enough among patients with T2DM to achieve CV risk factor control; failing to efficaciously identify T2DM patients with already established CV complications; and failing proactively to assess individuals at high risk for T2DM. This review discusses the apparent symbiosis between CV disease and T2DM, with a focus on identifying patients with established T2DM or at risk for T2DM; traditional and novel risk factors and markers for CV disease in T2DM; challenges related to diagnosing CV disease in T2DM; and organization of T2DM care in order to prevent CV complications. These are issues that require attention because identifying patients at high risk for T2DM can halt or reduce their further glycaemic deterioration if addressed properly, and because novel markers and non‐invasive tests could be applied in patients with T2DM as a means of detecting and possibly treating unrecognized CV disease in time. Furthermore, several approaches for T2DM care can be effective in controlling the CV risk factors contributing to CV complications.     

Inflammation and coronary angiography in asymptomatic type 2 diabetic subjects

OBJECTIVE: Coronary artery disease (CAD) is prevalent in patients with type 2 diabetes mellitus (T2DM) and because it is often asymptomatic and extensive in comparison with CAD in subjects without diabetes, it represents a diagnostic challenge. The objective of the study was to investigate the prevalence of CAD in asymptomatic T2DM patients utilizing angiography and to investigate its association with cardiovascular (CV) risk factors, the metabolic syndrome and markers of inflammation. MATERIAL AND METHODS: Eighty-two patients with T2DM without symptoms of CAD, and with >or=1 CV risk factor (hypertension, dyslipidaemia, premature familial CAD, smoking or microalbuminuria) underwent a diagnostic stress test and coronary angiography irrespective of stress test results. Stenosis detected in the main coronary arteries >or=50% of lumen diameter was categorized as one-, two- or three-vessel disease. Inflammatory markers were analysed in fasting samples. RESULTS: Fifteen men and two women had significant CAD (21%) (1-vessel disease, n=10; 2- or 3-vessel disease, n=7). Patients with 2- or 3-vessel disease were significantly older and had a longer duration of diabetes, but the prevalence of other traditional CV risk factors or the metabolic syndrome was similar among those with 1-vessel and those with 2- or 3-vessel disease. Sensitivity for CAD of the stress test was low (0.35). The mean level of the pro-inflammatory marker interleukin-6 was elevated in patients with 2- to 3-vessel CAD as compared to patients with no or 1-vessel CAD (p<0.05). CONCLUSIONS: Significant CAD was found in 21% of asymptomatic patients with T2DM with >or=1 CV risk factor. Inflammatory markers may be helpful in identifying patients that are likely to have significant CAD, but larger studies are warranted.     

2型糖尿病患者微量白蛋白尿与冠心病的关系

目的探讨2型糖尿病患者微量白蛋白尿(MAU)与冠心病(CHD)的关系。方法98例2型糖尿病患者,依有无并发CHD分为糖尿病并CHD组(28例)和糖尿病不并CHD组(70例),分析比较两组心血管疾病危险因素。再依微量白蛋白尿含量分为微量白蛋白尿组(43例)和非白蛋白尿组(55例),比较两组CHD的发生率。结果糖尿病并CHD组微量白蛋白尿含量明显高于不并CHD组[(56±32)mg/L和(22±15)mg/L,P<0.01];微量白蛋白尿组并发CHD的发生率显著高于非白蛋白尿组(41.86%和18.18%,P=0.01)。结论检测微量白蛋白尿是预测2型糖尿病患者CHD发病率的有意义的指标。     

CT冠状动脉成像与冠状动脉导管造影评估冠状动脉钙化所致狭窄程度的一致性

目的 探讨CT冠状动脉成像(CTCA)与冠状动脉导管造影(ICA)评估冠状动脉钙化狭窄程度的一致性。方法 选取接受CTCA和ICA、且图像无明显伪影的45例冠状动脉钙化狭窄患者;分别测量其病灶处钙化CT值、血管CT值,计算二者的CT比值,即血管钙化CT比值=病灶周围钙化最高CT值/病灶周围血管近端无钙化层面的血管CT值。以所用患者血管钙化CT比值的总平均值为分界值,将病例分为A、B两组。分别比较两组中CTCA与ICA诊断冠状动脉钙化狭窄程度的一致性。结果 45例患者血管钙化CT比值的总平均值为3.04±0.89;A组血管钙化CT比值<3.04,共21例,CTCA与ICA对其狭窄程度评估的吻合率为95.24%(20/21),诊断一致性极好(Kappa=0.82,P<0.05);B组血管钙化CT比值≥3.04,共24例,CTCA与ICA对其狭窄程度评估的吻合率为37.50%(9/24),诊断一致性差(Kappa=0.172,P<0.05)。结论 当血管钙化CT比值<3.04时,采用CTCA评估冠状动脉钙化狭窄程度,与ICA的评估结果具有较好的一致性。     

2型糖尿病合并冠心病患者血清 SPARC 水平与冠状动脉病变的关系

目的：探讨2型糖尿病合并冠心病患者血清中富含半胱氨酸的酸性分泌蛋白(SPARC)水平变化及与冠状动脉病变的关系。方法选取120例患者作为研究对象,采用酶联免疫吸附实验(ELISA)检测血清 SPARC 水平,应用 Gensini 积分评价冠状动脉病变程度。A 组为健康对照组40例,根据造影结果和1999年世界卫生组织(WHO)糖尿病诊断标准将患者分为 B、C、D 组：其中 B 组(单纯2型糖尿病组)40例、C 组(单纯冠心病组)40例、D 组(2型糖尿病合并冠心病组)40例。结果①B 组、C 组和 D 组血清 SPARC 水平高于 A 组(4.22±1.19)μg/L、(3.71±1.05)μg/L、(5.96±1.40)μg/L vs (3.60±0.40)μg/L(P 均<0.05),其中 D 组血清 SPARC 水平最高(P <0.05)。②血清 SPARC 水平、胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbA1 c)是冠心病的影响因素。③D 组血清 SPARC 水平与 Gensini 积分呈正相关(r =0.770,P <0.05),C 组 SPARC 水平与 Gensini 积分无相关性(r =0.520,P >0.05)。④ Pearson 相关分析显示：甘油三酯(TG)、FINS、HOMA-IR 与 SPARC 呈显著正相关(r 分别为0.780、0.762、0.891,P 均<0.05)。结论2型糖尿病合并冠心病患者血清 SPARC 水平升高,并且与冠状动脉病变程度显著相关。     

糖尿病与冠状动脉病变程度的关系(附170例报告)

目的:探讨2型糖尿病与冠状动脉病变程度的关系。方法:2004年5月-2006年2月疑为冠心痛的患者行冠状动脉造影170例。观察冠状动脉及其分支的病变,并分别对冠状动脉管腔内径狭窄程度、长度、冠状动脉病变支数进行评价,冠状动脉狭窄程度采用Gensini定量评定法。结果:2型糖尿病患者冠状动脉病变血管数、病变狭窄程度、病变长度、均高于非糖尿病患者。糖尿病患者冠状动脉造影阳性率高于非糖尿病者,但差异无统计学意义(75％比69％,P>0．05);糖尿病患者多支病变率明显高于非糖尿病组(58％比38％,P=0．015);糖尿病患者斑块积分亦大于非糖尿病组(8．03±7．37比6．68±8．45,P=0．027)。结论:2型糖尿病患者更易出现冠状动脉动脉造影显示的复杂病变,多支病变,严重病变。故有效地控制糖代谢紊乱在干预冠状动脉粥样硬化发生和发展中具有重要意义。     

冠心病合并2型糖尿病患者冠状动脉病变与胰岛素抵抗的相关性分析

目的探讨冠心病合并2型糖尿病患者冠状动脉缺血及钙化程度与胰岛素抵抗的相关性。方法选择2020年1月1日至2022年1月1日在上饶市人民医院明确诊断为冠心病且伴有2型糖尿病的患者80例。根据稳态模型的胰岛素抵抗指数(insulin resistance index in a homeostasis model,HOMA-IR)将患者分为两组:HOMA-IR>2.69为A组(n=42)、HOMA-IR≤2.69为B组(n=38),并比较两组靶血管钙化长度、靶血管钙化弧度、冠状动脉病变支数、支架覆盖病变长度及Gensini积分的差异性,以及HOMA-IR与上述各项指标的相关性。结果与B组比较,A组靶血管钙化长度较长、靶血管钙化弧度较大、冠状动脉病变数目较多、支架覆盖病变长度较长、Gensini积分较高,差异均有统计学意义(P<0.05)。Pearson相关分析显示,靶血管钙化长度、靶血管钙化弧度、冠状动脉病变数目、支架覆盖病变长度、Gensini积分与HOMA-IR呈正相关(r分别为0.75、0.51、0.43、0.38、0.59,均P<0.05)。结论冠心病合并2型糖尿病的患者胰岛素抵抗与冠状动脉缺血及钙化程度呈正相关。     

老年急性冠脉综合征合并糖尿病患者冠脉造影分析

目的探讨老年急性冠脉综合征合并糖尿病患者冠状动脉病变的特点。方法对69例老年急性冠脉综合征患者行冠脉造影检查,其中合并2型糖尿病组21例,未合并糖尿病组48例,分析两组患者临床资料及冠脉病变特点。结果两组性别、年龄、肥胖、吸烟、高血压、高脂血症等差异均无统计学意义(P>0.05);与非合并糖尿病组比较,合并糖尿病组冠状动脉以多支血管病变为主(85.7%),其中合并三支血管病变差异有统计学意义[14(66.7)vs 17(35.4),P=0.016];合并糖尿病组重度狭窄或完全闭塞达(66.7%),其中重度狭窄90%≤D<99%与非糖尿病组比较差异有统计学意义[11(52.4)vs 11(22.9),P=0.016]。结论老年急性冠脉综合征合并糖尿病患者冠状动脉以三支血管病变为主,重度狭窄为主。     

自我护理对2型糖尿病患者并发冠心病危险因素的影响

目的：糖尿病患者更容易发生冠心病,本研究探讨糖尿病患者发生冠心病的独立危险因素,并研究自我护理对这些危险因素的影响。方法：我们连续入选2型糖尿病患者423例,其中单纯糖尿病患者182例,合并冠心病的患者241例。采集两组患者的病史资料和实验室检查结果,用多因素Logistic逐步回归分析这些糖尿病患者发生冠心病的关键危险因素,并探讨自我护理对这些危险因素的影响。结果：发现高血压、血脂异常、血糖控制差、肾功能减退等是糖尿病冠心病发生的独立危险因素。另外,对于这些危险因素,单纯糖尿病组和糖尿病合并冠心病组患者之间的自我护理方面存在显著差异(P<0.001)。结论：在2型糖尿病患者中,高血压、血脂异常、血糖控制差、肾功能减退等因素与冠心病的关联密切。积极的自我护理能够有效干预糖尿病并发冠心病的危险因素。     

颈动脉内膜中层厚度对2型糖尿病伴发冠心病患者的诊断价值

目的探究最大颈动脉内膜中层厚度(cIMT)对2型糖尿病(T2DM)伴发冠心病患者的诊断价值。方法对40例T2DM伴发冠心病患者(观察组)与50例T2DM无伴发冠心病患者(对照组)的最大cIMT及实验室指标进行检测,分析T2DM伴发冠心病与最大cIMT的相关性。结果观察组患者的最大cIMT、高密度脂蛋白水平及年龄分别为1.31(1.11,1.42)mm、(1.02±0.12)mmol/L、(64.52±7.25)岁,与对照组的1.00(0.79,1.25)mm、(1.18±0.32)mmol/L、(55.58±10.02)岁,差异均有统计学意义(P0.05或0.01);经单因素筛选与多元回归分析后,患者的年龄、最大cIMT均是T2DM伴发冠心病的独立危险因素(P0.05);受试者工作特征曲线分析显示,最大cIMT对T2DM伴发冠心病的诊断特异性与敏感性分别为70.0%与75.0%。结论 T2DM伴发冠心病与最大cIMT有关,cIMT对冠心病患者具有较高的独立预测价值,可作为T2DM患者伴发冠心病的诊断指标。     

前列腺素E1对2型糖尿病合并冠心病患者血液流变学的影响

目的:研究2型糖尿病合并冠心病患者血液流变学改变及其前列腺素E1治疗对其的影响.方法:对86例2型糖尿病患者(其中合并冠心病患者53例,单纯糖尿病患者33例)进行血液流变学指标检测,并与对照组比较,2型糖尿病合并冠心病患者采用前列腺素E1治疗,观察其血液流变学的改变.结果:与对照组相比,2型糖尿病患者的全血高切黏度、全血低切黏度、血浆黏度、纤维蛋白原、红细胞聚集指数和血小板聚集率均明显升高(P＜0.05),红细胞变形指数明显降低(P＜0.05),其中糖尿病合并冠心病组变化更为显著(P＜0.05).前列腺素E1可以明显降低糖尿病合并冠心病患者的血液黏度和血小板聚集率(P＜0.05).结论:2型糖尿病合并冠心痛患者的血液黏度和血小板聚集性增高,前列腺素E1可以明显改善血流动力学和微循环.     

Assessment of the presence and extent of coronary collateralization by coronary computed tomographic angiography in patients with total occlusions

Coronary computed tomography angiography (CTA) may be helpful to manage patients with chronic coronary occlusions. The aim of this study was to determine the sensitivity and specificity of CTA to detect the presence and extent of coronary collaterals as compared to invasive coronary angiography (ICA). We retrospectively evaluated 26 patients who underwent both coronary CTA and ICA within 3 weeks and demonstrated a total coronary occlusion (TIMI grade 0) in one of the major coronary arteries. CTA was performed using a 64-slice multidetector CT. The presence, and extent of collateralization was assessed by two blinded observers using the Rentrop classification for ICA. CTA accurately identified the presence and location of all 26 total occlusions. The presence of any collaterals was accurately detected in 21/23 patients [sensitivity 91% (CI: 71–98%)] and the absence in three patients [specificity 100% (CI: 29%–100%)]. The sensitivity of coronary CTA to identify patients with collateralization increased from 91 to 94% (CI: 71–99%) and 100% (CI: 59–100%) for collaterals Rentrop grade 2 and 3 in ICA, respectively. Coronary CTA accurately detects the presence of any coronary collateralization in patients with total occlusions. Although CT technology is currently limited in the assessment of individual collaterals and smaller vessels, it may be helpful in the management of patients with total occlusions.     

Lipoprotein(a), type 2 diabetes and vascular risk in coronary patients

BACKGROUND: Lipoprotein(a) [Lp(a)] is an important cardiovascular risk factor in the general population. However, prospective data on the vascular risk conferred by Lp(a) in patients with diabetes mellitus are scarce and controversial. It is not known whether the diabetic state affects the association of Lp(a) with vascular events among coronary patients. DESIGN: We measured Lp(a) in 587 consecutive patients undergoing coronary angiography for the evaluation of coronary artery disease. The incidence of vascular events was recorded over 4 years. RESULTS: At baseline, Lp(a) was significantly lower in patients with type 2 diabetes (T2DM) (n = 136) than in nondiabetic individuals (11 (0.8-30) mg dL(-1) vs. 16 (0.8-51) mg dL(-1); P = 0.025). Prospectively, Lp(a) was a strong and independent predictor of vascular events in nondiabetic patients (standardized adjusted hazard ratio (HR) = 1.461 (1.121-1.904); P = 0.005), but not in patients with T2DM [HR = 0.812 (0.539-1.223); P = 0.320]. An interaction term diabetes x Lp(a) was significant (P = 0.008), indicating that Lp(a) was a significantly stronger predictor of vascular events in nondiabetic patients than in patients with T2DM. CONCLUSIONS: Lp(a) in diabetic coronary patients is low and not associated with the incidence of vascular events. Although measurement of Lp(a) provides useful information in nondiabetic coronary patients, it is of little value in coronary patients with T2DM.     

Serum homocysteine,creatinine, and glucose as predictors of the severity and extent of coronary artery disease in asymptomatic members of high-risk families

BACKGROUND: There has been no previous study to determine the severity and extent of coronary artery disease (CAD) in subjects with no diagnosis or symptoms of CAD at the time of the angiography. METHODS: Fifty-three subjects, who were siblings of patients with early onset CAD, underwent coronary angiography. Indices to describe per-patient characteristics of CAD were calculated, based on computer-aided quantitative coronary angiography. Clinical and laboratory characteristics were correlated to the angiographic parameters. RESULTS: Serum total homocysteine (rho = 0.29, P < 0.05) and creatinine (rho = 0.47, P = 0.001) levels were related to the global atheroma burden index. The median of the atheroma burden index was two times higher in the top homocysteine quartile compared to the lowest quartile. The overall atheroma burden index correlated significantly with the fasting blood glucose level in all subjects. Diabetes, especially when albuminuria was present, was a powerful risk factor. In a multivariate analysis, only age and sex were independent predictors of atheroma burden. CONCLUSIONS: Serum homocysteine and creatinine concentrations, and diabetes with albuminuria were found to be markers of the severity and extent of CAD in subjects of high-risk families without symptoms of CAD.     

2型糖尿病患者微量白蛋白尿与早期动脉硬化关系的研究

目的探讨2型糖尿病患者微量白蛋白尿与早期动脉硬化的关系。方法90例2型糖尿病患者,根据尿白蛋白排泄率(UAER)分为3组,即DM-A组(UAER<20μg/min),DM-B组(UAER 20~200μg/min),DM-C组(UAER>200μg/min),采用高分辨率的彩色多普勒超声波仪器测量各组2型糖尿病患者颈总动脉内膜-中层厚度(IMT),并与尿白蛋白量、病程、血糖、糖化血红蛋白(GHbA1c)、血压、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)进行多元相关分析。结果IMT在2型糖尿病3个组中差异有统计学意义(P<0.05),其中DM-C组IMT高于DM-A和DM-B组(均P<0.05),而DM-B组高于DM-A组(P<0.05);IMT与尿白蛋白量、病程、血糖、GHbA1c、血压、TG、LDL-C呈线性相关(r值分别为0.582、0.467、0.413、0.483、0.423、0.517、0.529,均P<0.05)。结论伴微量白蛋白尿的糖尿病患者存在早期动脉硬化。     

老年2型糖尿病合并冠心病与非糖尿病冠状动脉造影分析

目的　了解 2型糖尿病合并冠心病的老年患者与非糖尿病冠心病患者冠状动脉病变的特点。方法　对6 4例 2型糖尿病合并冠心病的老年患者与 1 2 2例非糖尿病冠心病患者行冠状动脉造影并将结果进行比较分析。结果　两组病变血管数目、平均病变血管支数、弥漫性方面差异有统计学意义 (P <0 .0 0 5 ,P <0 .0 0 1 ,P <0 .0 1 ) ,而且两组在冠状动脉病变总记分间比较差异也有统计学意义 (P <0 .0 1 ) ,但病变血管狭窄程度方面差异无统计学意义(P >0 .0 5 )。结论　 2型糖尿病合并冠心病患者病变血管数目较多 ,血管病变弥漫。     

伴有2型糖尿病的冠心病患者血中C反应蛋白的变化

目的了解伴有2型糖尿病的冠心病患者血中C反应蛋白(CRP)的变化,探讨糖尿病对CRP的影响.方法采用酶联免疫法对经冠状动脉造影证实的慢性稳定性心绞痛患者测定血清CRP,其中伴有2型糖尿病(DM)患者53例,无糖尿病患者38例.结果在冠心病患者中,DM较无DM者CRP显著增高;而且冠心病患者中DM合并陈旧性心梗者的CRP亦较无DM的陈旧性心梗者显著增高;单因素回归分析示CRP与血总胆固醇、低密度脂蛋白和甘油三酯水平显著正相关,而与HDL显著负相关.结论 CRP在糖尿病合并冠心病患者血中更显著增高,提示炎症反应在糖尿病致动脉粥样硬化形成中起重要作用.     

3.0T磁共振全心冠状动脉成像在诊断冠状动脉狭窄中的临床价值

目的 探讨3.0T磁共振全心冠状动脉成像在冠状动脉狭窄诊断中的临床应用价值.方法 应用3.0T MR自由呼吸三维导航快速梯度回波序列,对30例临床怀疑为冠心病患者进行MR全心冠状动脉成像检查,完成MR检查的27例中有19例进行了行冠状动脉造影检查,以血管造影为"金标准",初步估价3.0T磁共振全心冠脉成像诊断冠状动脉狭窄(>50%)的敏感性、特异性、准确度、阳性预测值及阴性预测值.结果 30例进行MR全心冠状动脉成像的患者中,27例获得了满意的检查结果(84.5%),MR全心冠状动脉成像检查在进行了冠状动脉造影检查的患者中共发现24支冠状动脉显著狭窄.与冠状动脉造影结果对照,MR全心冠状动脉成像诊断冠状动脉显著性狭窄敏感性为73.91%,特异性为82.29%,准确度为77.19%,阳性预测值为70.83%,阴性预测值为87.88%.结论 3.0T磁共振全心冠脉成像能够无创性地进行冠状动脉成像,初步评价冠状动脉主干及近、中段狭窄.冠状动脉MRA表现了较高的阴性预测值,对排除冠状动脉狭窄具有较高的临床应用价值.