Pundziute Gabija, Schuijf Joanne D, Jukema J Wouter, Boersma Eric, Scholte Arthur J H A, Kroft Lucia J M, van der Wall Ernst E, Bax Jeroen J
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Diabetes Care. 2007 May;30(5):1113-9. doi: 10.2337/dc06-2104. Epub 2007 Jan 26.
Cardiovascular events are high in patients with type 2 diabetes, whereas their risk stratification is more difficult. The higher risk may be related to differences in coronary plaque burden and composition. The purpose of this study was to evaluate whether differences in the extent and composition of coronary plaques in patients with and without diabetes can be observed using multislice computed tomography (MSCT).
MSCT was performed in 215 patients (86 [40%] with type 2 diabetes). The number of diseased coronary segments was determined per patient; each diseased segment was classified as showing obstructive (> or = 50% luminal narrowing) disease or not. In addition, plaque type (noncalcified, mixed, and calcified) was determined. Plaque characteristics were compared in patients with and without diabetes. Regression analysis was performed to assess the correlation between plaque characteristics and diabetes.
Patients with diabetes showed significantly more diseased coronary segments than nondiabetic patients (4.9 +/- 3.5 vs. 3.9 +/- 3.2, P = 0.03) with more nonobstructive (3.7 +/- 3.0 vs. 2.7 +/- 2.4, P = 0.008) plaques. Relatively more noncalcified (28 vs. 19%) and calcified (49 vs. 43%) and less mixed (23 vs. 38%) plaques were observed in patients with diabetes (P < 0.0001). Diabetes correlated with the number of diseased segments and nonobstructive, noncalcified, and calcified plaques.
Differences in coronary plaque characteristics on MSCT were observed between patients with and without diabetes. Diabetes was associated with higher coronary plaque burden. More noncalcified and calcified plaques and less mixed plaques were observed in diabetic patients. Thus, MSCT may be used to identify differences in coronary plaque burden, which may be useful for risk stratification.
2型糖尿病患者心血管事件发生率较高，而其风险分层更为困难。较高的风险可能与冠状动脉斑块负荷和成分的差异有关。本研究的目的是评估使用多层计算机断层扫描（MSCT）是否能观察到糖尿病患者与非糖尿病患者冠状动脉斑块范围和成分的差异。
对215例患者（86例[40%]为2型糖尿病患者）进行了MSCT检查。确定每位患者病变冠状动脉节段的数量；每个病变节段分为显示阻塞性（管腔狭窄≥50%）病变或非阻塞性病变。此外，确定斑块类型（非钙化、混合和钙化）。比较糖尿病患者与非糖尿病患者的斑块特征。进行回归分析以评估斑块特征与糖尿病之间的相关性。
糖尿病患者的病变冠状动脉节段明显多于非糖尿病患者（4.9±3.5对3.9±3.2，P = 0.03），非阻塞性斑块更多（3.7±3.0对2.7±2.4，P = 0.008）。糖尿病患者中观察到相对更多的非钙化斑块（28%对19%）和钙化斑块（49%对43%），混合斑块较少（23%对38%）（P < 0.0001）。糖尿病与病变节段数量以及非阻塞性、非钙化和钙化斑块相关。
糖尿病患者与非糖尿病患者在MSCT上的冠状动脉斑块特征存在差异。糖尿病与较高的冠状动脉斑块负荷相关。糖尿病患者中观察到更多的非钙化和钙化斑块，混合斑块较少。因此，MSCT可用于识别冠状动脉斑块负荷的差异，这可能有助于风险分层。
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