定量冠状动脉造影对糖尿病患者靶病变及参考血管的评价

目的 对比血管内超声(IVUS)与定量冠状动脉造影(QCA)对于冠心病合并糖尿病患者靶病变和参考血管定量测量结果,评价QCA的准确性,以指导临床的干预治疗.方法 2型糖尿病患者52例,男35例,女27例,年龄(62.3±7.1)岁.接受QCA和IVUS检查.以IVUS测量最小面积处斑块负荷结果作为因变量,以QCA定量测量的病变血管狭窄程度作为自变量,进行相关和回归分析,得到相关系数,建立回归方程.并对比近、远端参考血管直径两类方法测量值.结果 QCA冠状动脉狭窄程度测量结果同IVUS最小面积处斑块负荷结果的回归方程(斜率:0.8286,P=0.001)显示二种方法的测量结果有明确的同步变化趋势和相关性(r=0.691,P＜0.001).但QCA测量结果(57.9%±15.5%)较ivus(53.5%±12.9%)高估了病变的严重程度(差值为4.6%±1.2%).本组患者为血管负性重构,重构指数(RI)为0.87±0.23.相对于近、远端参考血管的管腔直径测量误差(0.24±0.06)mm和(0.07±0.01)mm]而言,QCA对近、远端参考血管的血管直径的测量误差(0.81±0.24)mm和(0.64±0.17)mm]更为明显.结论由于糖尿病患者广泛的血管重构(尤其是负性重构),使QCA易高估罪犯血管严重程度.同时,QCA因无法准确显示斑块负荷,而导致造影显示为"正常"血管段,从而低估近远端参考血管直径.

Quantitative coronary angiography and intravascular ultrasound assessments on target lesion and reference vessel in patients with diabetes mellitus

Objective To evaluate the accuracy of quantitative coronary angiography ( QCA ) assessment on target lesion and reference vessel in patients with diabetes mellitus with intravascular ultrasound (IVUS) measurements as golden standard. Methods QCA and IVUS were performed in 52 diabetes mellitus patients 35 males, mean age (62.3 ±7. 1)years]. Regression equation was ascertained with the IVUS derived plaque burden as dependent and QCA derived vessel stenosis as independent variable. The measurement results derived from the two modalities on proximal and distal reference vessels were compared. Result The regression equation (constant = 0. 8286, P = 0. 001) of plaque burden and vessel stenosis derived from two modalities were significantly correlated ( r = 0. 691, P < 0. 001 ) but QCA overestimated the stenosis severity (57. 9% ± 15. 5% vs. 53. 5% ± 12. 9% , P <0. 01 ). Target vessels negative remodeling index in these patient was 0. 87 ±0.23. QCA significantly underestimated the proximal and distal reference segments vessel diameters ( 0. 81 ± 0. 24 ) mm, ( 0. 64 ± 0. 17 ) mm, all P < 0. 05 ] as compared to IVUS results. Conclusion Due to the significant negative vessel remodeling, QCA overestimated the stenosis severity and underestimated the reference segments vessel diameters in patients with diabetes mellitus.