320排CT在糖尿病冠状动脉粥样硬化斑块形态学及管腔重构的研究

目的：评估糖尿病（DM）和无DM患者320排冠状动脉CT造影（ccTA）冠状动脉粥样硬化斑块形态学及管腔重构的不同。方法：比较由于胸痛和冠心病的筛查而接受320排CCTA检查的232例DM患者和487例无DM患者的冠状动脉粥样硬化斑块形态学及管腔重构。结果：DM患者与无DM患者相比较，DM患者单支血管病变发生率低（X2=5．434，P〈0．05）；2支血管病变发病率相似（X2=0．912，P〉0．05）；而3、4支血管病变发病率高（X2=4．887，P〈0．05）；单因素分析显示，DM组混合性斑块、梗阻性斑块以及阳性重构（PR）发病率高（X2=4．214，X2=4．415，X2=6．215；P〈0．05），而多因素Cox比例风险回归模型分析显示，仅PR与DM呈正相关（危害比5．61（2．11-14．71，95％CI），P〈0．001）。结论：与无DM患者比较，DM患者有较高的多支血管病变发病率，高的MP负荷以及PR，预示有更高发生急性冠状动脉事件的可能性。

Assessment on 320-rows coronary computed tomography angiography differences in morphology of coronary atherosclerotic plaques and vascular remodeling in diabetes and non-diabetes

Objective： To assess differences in morphology of coronary atherosclerotic plaque and vascular remodeling as detected by 520-rows coronary computed tomography angiography between patients with and without diabetes mellitus. Methods： We compared coronary atherosclerotic plaques and vascular remodeling between 252 diabetic patients and 487 non-diabetic patients who underwent 520-rows coronary computed tomography angiography （CCTA） for the evaluation of chest pain and coronary artery disease screening. Results： Patients with diabetes had a lower prevalence of single vessel lesion（x2=5.434, 〈 0.05）, a similar 2 vessels lesions（x2=0.912, P〈0.05）, and a higher prevalence of 5 （x2=4.887, P〈 0.05）and 4 vessels lesionsas compared to patients without diabetes. Segment-based single factor analysis showed that MP, obstructive plaque, and positive remodeling had a higher prevale with diabetes as compared without diabetes（x2=4.214, x2=4.415, x2=6.215; P 〈 0.05, respectively）. Segment-based Cox proportional hazards models analysis showed that only positive remodeling were positively correlated with diabetes（r=5.61, P〈 0.001）. Conclusion： Patients with diabetes have a higher prevalence of multiple vessels lesions, ME and positive remodeling as compared to patients without diabetes. It is possible that they have a higher morbidity of acute coronary events.