Mid America Heart Institute, University of Missouri-Kansas City, Saint Luke's Hospital, Kansas City, MO 64111, USA.
Circ Cardiovasc Interv. 2009 Dec;2(6):543-8. doi: 10.1161/CIRCINTERVENTIONS.109.876672. Epub 2009 Oct 13.
Coronary plaque classified as thin-cap fibroatheroma (TCFA) is believed to be associated with plaque rupture and coronary heart disease-related events. Although an association between duration of diabetes and increased coronary heart disease risk has been demonstrated, the relationship between TCFA and diabetes duration is unknown.
Prospective registry of diabetic patients undergoing diagnostic coronary angiography and intravascular ultrasound (IVUS) enrolled in a diabetic gene and biomarker banking registry. Plaque composition in the most diseased 10-mm segment of a single coronary artery was assessed using IVUS virtual histology and was classified by phenotype as IVUS-defined adaptive intimal thickening, pathological intimal thickening, TCFA, fibroatheroma, or fibrocalcific. Patients (n=54) were stratified by duration of diabetes (<10 or > or = 10 years). Patients with diabetes > or = 10 years were older, less likely to have a history of tobacco use, had higher total cholesterol levels, and were more likely to be treated with insulin compared with patients with diabetes <10 years. Longer duration of diabetes was associated with greater plaque burden in the most diseased 10-mm segment (60.4% [53.4% to 66.8%] versus 50.2% [47.7% to 58.4%], P=0.008). The proportion of IVUS-defined TCFA in the > or = 10-year group was greater than the <10-year group (54.4% [11.6% to 77.5%] versus 10.8% [0.0% to 26.1%], P=0.009). This association persisted after adjustment for multiple comparisons, clinical characteristics, and diabetes treatment.
In this cohort, longer duration of diabetes was associated with IVUS-defined TCFA, a plaque phenotype associated with risk of rupture and coronary heart disease events.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00428961.
薄帽纤维粥样斑块（TCFA）被认为与斑块破裂和冠心病相关事件有关。虽然已经证明糖尿病持续时间与增加冠心病风险之间存在关联，但 TCFA 与糖尿病持续时间之间的关系尚不清楚。
这项前瞻性研究纳入了接受诊断性冠状动脉造影和血管内超声（IVUS）检查的糖尿病患者，并登记在糖尿病基因和生物标志物银行注册中心。使用 IVUS 虚拟组织学评估单个冠状动脉中最严重的 10mm 节段的斑块成分，并根据表型分为 IVUS 定义的适应性内膜增厚、病理性内膜增厚、TCFA、纤维粥样斑块或纤维钙化斑块。患者（n=54）按糖尿病持续时间（<10 年或≥10 年）分层。糖尿病持续时间≥10 年的患者年龄更大，吸烟史更少，总胆固醇水平更高，且更可能接受胰岛素治疗，而非糖尿病持续时间<10 年的患者。较长的糖尿病持续时间与最严重的 10mm 节段的斑块负荷更大相关（60.4%[53.4%至 66.8%] 与 50.2%[47.7%至 58.4%]，P=0.008）。≥10 年组的 IVUS 定义 TCFA 比例大于<10 年组（54.4%[11.6%至 77.5%] 与 10.8%[0.0%至 26.1%]，P=0.009）。调整了多次比较、临床特征和糖尿病治疗后，这种关联仍然存在。
在本队列中，糖尿病持续时间较长与 IVUS 定义的 TCFA 相关，这是一种与破裂风险和冠心病事件相关的斑块表型。
