Sumin A N, Bezdenezhnykh N A, Bezdenezhnykh A V, Ivanov S V, Barbarash O L, Barbarash L S
Kardiologiia. 2012;52(11):33-41.
Aim of the study was investigation of influence of diabetes mellitus (DM) on rate of detection of multifocal atherosclerosis (MFA) in patients with ischemic heart disease (IHD) at examination before coronary artery bypass grafting (CABG). We retrospectively analyzed 2411 hospital forms of patients with IHD subjected to CABG. DM was found in 317 patients (group 1). Control group (n=350) comprised patients of comparable sex and age without DM. Clinico-anamnestic data, parameters of coronary angiography, ultrasound and angiographic study of the aorta, brachiocephalic and peripheral arterial beds were compared between these groups. Patients with diabetes compared with patients of the control group more frequently had increased thickness of intima media complex (92 and 77%, respectively; p=0.0001). Simultaneous involvement of 2 or more arterial beds were detected in 46.1% of patients with DM and in 33.1% of control patients. Involvement of only one (coronary) arterial basin was more frequent in patients without DM (p=0.0001). Multifactorial analysis showed that independent effect on detection of MFA produced intima media thickness, presence of DM and history of acute disturbance of brain circulation. Thus among patients with IHD MFA before CABG was found in 46.1% of patients with DM and 33.1% of similar sex and age patients without DM. Patients with DM require focused examination for detection of manifestations of MFA and conduct of necessary curative and preventive interventions.
本研究的目的是调查糖尿病(DM)对缺血性心脏病(IHD)患者在冠状动脉旁路移植术(CABG)术前检查中多灶性动脉粥样硬化(MFA)检出率的影响。我们回顾性分析了2411例接受CABG的IHD患者的医院病历。317例患者(第1组)被发现患有DM。对照组(n = 350)由性别和年龄相仿但无DM的患者组成。对这两组患者的临床病史资料、冠状动脉造影参数、主动脉、头臂动脉和外周动脉床的超声及血管造影研究结果进行了比较。与对照组患者相比,糖尿病患者内膜中层复合体厚度增加更为常见(分别为92%和77%;p = 0.0001)。46.1%的糖尿病患者和33.1%的对照患者被检测出同时累及2个或更多动脉床。无DM的患者中仅累及一个(冠状动脉)动脉区域更为常见(p = 0.0001)。多因素分析表明,对MFA检出有独立影响的因素包括内膜中层厚度、DM的存在以及脑循环急性障碍病史。因此,在IHD患者中,46.1%的糖尿病患者和33.1%性别和年龄相仿的非糖尿病患者在CABG术前被发现患有MFA。糖尿病患者需要进行针对性检查以发现MFA的表现并进行必要的治疗和预防干预。