糖尿病和非糖尿病胸痛患者64层螺旋CT冠状动脉斑块特点的对照研究

目的利用64层螺旋cT冠状动脉造影研究糖尿病和非糖尿病胸痛患者冠状动脉斑块的特点。方法收集120例胸痛患者（糖尿病组60例，非糖尿病组60例）64层螺旋cT冠状动脉造影成像资料，观察2N患者冠状动脉斑块的分布特点与类型，并进行对照研究。并将糖尿病组60例患者根据病程将其分成3组（〈5年，5-10年，〉10年），并对各组冠状动脉狭窄及斑块性质进行评价。结果本组120例患者共计1800段血管进行分析，其中糖尿病组存在斑块297段，而非糖尿病组存在斑块119段（χ2=99．057，P〈0．01），糖尿病组单支病变的比例明显少于非糖尿病组，糖尿病组2支及以上的病变发生率明显高于非糖尿病组（P〈0．01）。受累血管段分布中，以左冠前降支受累差异有统计学意义（χ2=5．626，P〈0．05），而左冠主干、回旋支及右侧冠状动脉均无明显差异。在斑块类型分布中，糖尿病组以软斑块和混合斑块为主（P〈0．05）。60例糖尿病患者中，〈5年组斑块发生率14．2％（64／450），病变以软斑块为主，管腔以轻度狭窄为主；5～10年组斑块发生率为46．7％（112／240），病变以混合性斑块为主，管腔呈现中度狭窄为主；〉10年组斑块发生率57．6％（121／210），病变以混合斑块和钙化斑块为主，管腔多呈中．重度狭窄。结论64层螺旋CT冠状动脉造影能够比较准确地反映糖尿病和非糖尿病胸痛患者的粥样斑块之间的差异，同时能够准确识别斑块分布和特征，进行危险评估，指导临床选择合适的治疗方案。

The control study of 64-slice helical CT coronary artery plaque characteristics in patients with chest pain be- tween diabetes and non-diabetes mellitus

Objective To identify the coronary artery plaques characteristics in patients with chest pain be- tween diabetes and non-diabetes mellitus using 64-slice helical CT coronary angiography. Methods One hundred twenty cases of patients with chest pain （60 cases of diabetes, 60 eases of non-diabetes） receiving 64-slice helical CT coronary angiography were enrolled . It compared to find coronary artery plaque distribution characteristics and types, and diabetes group was further divided into three sub-groups： 〈Syear, 5-10year, 〉10year, then evaluated coronary artery stenosis and plaque property. Results In total, 1 800 section of the blood vessels with 120 patients were ana- lyzed, 297 coronary vessels segments in diabetes group and 119 coronary vessels segments in non-diabetes group were found to have plaques respectively（ χ2=99.057, P〈0.01 ）. Single vessel disease in diabetes group was obviously less than non-diabetes group, while two and multi-vessel disease in diabetes group was significantly more than the inci- dence in non-diabetes group （P〈0.01）. And left anterior descending coronary involved were affected most frequently in diabetes group （χ2=5.626, P〈0.05）, however the left main coronary artery, the left coronary artery cyclotron branch and right coronary artery had no obvious difference. Soft plaque and mixed plaque were major in diabetes group（P〈0.05）. Among 60 cases of diabetic patients, the plaque incidence rate was 14.2% （64/450）, soft plaque and slight stenosis were prior in 〈5 years group, the plaque incidence rate was 46.7% （112/240） in 5-10 year group, mixed plaque and moderate stenosis were found. The plaque incidence rate 57.6% in 〉10 years group （121/210） , mixed plaques and calcified plaque were more, and luminal stenosis were more severe. Conclusion Differences in coronary plaque properties between diabetic and non-diabetic patients with chest pain can be detected accurately by 64-slice helical CT coronary angiography, it also can identify plaque distribution and characteristi4s, for risk assessment, help to choice suitable treatment plan.