糖尿病和无糖尿病患者冠状动脉粥样硬化斑块范围和组成的320排冠状动脉CT造影评价

目的：评估糖尿病和无糖尿病患者320排冠状动脉 CT 造影（CCTA）冠状动脉粥样硬化斑块范围和组成的区别。方法比较由于胸痛和冠心病的筛查而接受320排CCTA 检查的108例糖尿病患者平均年龄（57.0±9.9）岁，64.8%为男性]和246例无糖尿病患者平均年龄（55.0±12.3）岁，62.2%为男性]的冠状动脉粥样硬化斑块总斑块，钙化斑块（CP），非钙化斑块（NCP）和混合斑块（MP）]。斑块的范围是指存在斑块节段数的连续变量。结果与无糖尿病患者比较，糖尿病患者单支血管病变发生率低（41.7%vs.72.0%，P=0.012），而2、3、4支血管病变发生率高（31.5%vs.19.1%，P=0.043；22.2%vs.8.9%，P=0.031；4.6%vs.0）；糖尿病患者的CP、NCP和MP发生率高（36.1%vs.32.9%，P=0.721；80.9%vs.39.0%，P〈0.001；74.1%vs.35.4%，P=0.009）和总斑块、CP、NCP和MP范围发生率亦高（4.88±3.91）个节段vs.（1.76±2.87）个节段，P〈0.001；（1.62±1.71）个节段vs.（0.55±1.83）个节段，P=0.039；（2.34±2.25）个节段vs.（0.78±1.65）个节段，P=0.019；（2.51±2.33）个节段vs.（0.97±1.54）个节段，P=0.026]。另外，糖尿病患者有着高的冠状动脉单发狭窄（34.3%vs.9.8%，P=0.047）和显著高的多发狭窄（21.3%vs.8.5%，P〈0.001）。结论与无糖尿病患者比较，糖尿病患者有较高的多支血管病变、单发和多发狭窄发生率以及高的总斑块、CP、NCP和MP负荷。预示有更高发生急性冠状动脉事件的可能性。

Assessment with 320-rows coronary computed tomography angiography in differences of extent and composition of coronary atherosclerotic plaques in diabetes and non-diabetes

Objective To assess differences in extent and composition of coronary atherosclerotic plaque burden by 320-rows coronary computed tomography angiography（CCTA） between patients with and without diabetes mellitus. Methods Coronary atherosclerotic plaques were compared any plaque, calcified plaque（CP）, non-calcified plaque（NCP）, and mixed plaque（MP）]between 108 diabetic patientsmean age：（57±9.9） years, 64.8%males]and 246 non-diabetic patients mean age：（55±12.3）years, 62.2%males]who underwent 320-rows CCTA for the evaluation of chest pain and coronary artery disease screening. The extent of plaque was defined as a continuous variable indicating the number of segments with plaque detected by 320-rows CCTA. Results Patients with diabetes had a lower prevalence of single vessel lesion（41.7%vs.72.0%, P=0.012）and a higher prevalence of 2, 3, 4 vessels lesions（31.5% vs.19.1%, 22.2% vs.8.9%, and 4.6% vs. 0, P=0.043, 0.031, respectively）as compared to patients without diabetes. Patients with diabetes had a higher prevalence of CP, NCP, and MP36.1%vs. 32.9%, P=0.721（however, this comparison did not reach statistical significance） , 80.9%vs. 39.0%, P〈0.001, and 74.1%vs. 35.4%, P= 0.009, respectively] and a higher extent of any plaque, CP, NCP, and MP （4.88±3.91 vs. 1.76±2.87, 1.62±1.71 vs. 0.55±1.83,2.34±2.25 vs. 0.78±1.65 and 2.51±2.33 vs. 0.97±1.54, P〈0.001, P=0.039, 0.019 and 0.026, respectively） as compared to patients without diabetes. In addition, patients with diabetes had a significant higher prevalence of coronary artery single stenosis and multiple stenosis （34.3%vs. 9.8%, P=0.047 and 21.3%vs.8.5%, P〈0.001） as compared to patients without diabetes.Conclusion Patients with diabetes have a higher prevalence of multiple vessels lesions, coronary artery single and multiple stenosis,and CP, NCP, and MP as compared to patients without diabetes. It is possible that they have a higher morbidity of acute coronary events.