2型糖尿病患者冠状动脉病变的危险因素分析

摘要

目的:探讨糖尿病患者冠状动脉病变的危险因素和冠状动脉CT血管造影(CT angiography,CTA)检查的安全性.方法:从2009年8月-2010年7月在复旦大学附属中山医院内分泌科住院的诊断为2型糖尿病且行冠脉CTA检查的患者中随机选择34例,根据冠脉病变支数及冠脉病变血管狭窄的程度将其分成阳性、阴性两组,分别比较患者的糖、脂代谢指标及冠脉CTA检查前后的肾功能等指标的变化.结果:冠脉病变阳性组较阴性组糖尿病病程长、空腹血糖及糖化血红蛋白(HbA1c)水平高(P均<0.05).偏相关分析显示,校正了性别、年龄、BMI后,冠脉病变支数与糖尿病病程、空腹血糖、HbA1c、24 h尿微量白蛋白呈正相关,而与C肽增值呈负相关(P均<0.05).冠脉CTA检查前后血肌酐差异无统计学意义(P>0.05).结论:病程长、HbA1c水平高的糖尿病患者,发生无症状冠心病的风险高,需进行冠心病筛查;对肾功能正常的糖尿病患者进行冠脉CTA检查是安全的.%Objective:To study the dangerous factors of coronary artery disease and the safety of coronary artery CT angiography (CTA) in patients with type 2 diabetes. Methods: A total of 34 subjects selected randomly from type 2 diabetes patients hospitalized in Department of Endocrinology and Metablism, Zhongshan Hospital ,Fudan University from August 2009 to July 2010 who underwent coronary artery CTA were involved in the study. Subjects were divided into two groups according to the number and the narrow degree of coronary artery lesions. The parameters of glucose and lipid metabolism, and renal function before and after the coronary artery CTA examination were compared between the two groups. Results: Duration of diabetes, fasting plasma glucose and HbA1c were higher in coronary artery lesions positive group than those in negative group(P all< 0. 05). Adjusted by gender,age,body mass index (BMI) ,the number of coronary artery lesions was positively correlated with duration of diabetes, fasting plasma glucose, HbA1c and 24h urine protein excretion rate, while it was negatively correlated with plus of C peptide(P all<0. 05). There was no significant difference in serum creatinine before and after the coronary artery CTA examination(P>0. 05). Conclusions: The longer duration and higher HbA1c levels of diabetes, the higher risk of asymptomatic coronary heart disease is , which need to be diagnosed by regular coronary heart disease examination. Coronary artery CTA examination is safe for patients with type 2 diabetes whose renal function is normal.