Yu Yi, Zhou Zhiwen, Sun Kun, Xi Lili, Zhang Lina, Yu Lingwei, Wang Jing, Zheng Jiayi, Ding Ming
Department of Ultrasound, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China.
Department of Cardiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China.
J Thorac Dis. 2018 Nov;10(11):6050-6059. doi: 10.21037/jtd.2018.10.62.
To assess the association between coronary artery atherosclerosis (CAA) and plasma glucose parameters in a randomly selected cohort of asymptomatic, community-dwelling, Chinese adults by dual-source computed tomography (DSCT).
We randomly selected participants and classified them into three groups based on their plasma glucose levels: normal glucose regulation (NGR), pre-diabetes, and diabetes mellitus (DM). The participants underwent DSCT, and those identified with CAA were divided into four groups according to the severity of their coronary artery stenosis. We analyzed the composition of plaques in all coronary artery segments according to the American Heart Association's (AHA) guidelines. We compared the severity of coronary artery stenosis and the plaque composition with plasma glucose parameters among participants.
Out of a total of 335 participants, 118 were found to have CAA. The prevalence of CAA was highest (P value for trend =0.031) in the diabetic group (67.7%) followed by the pre-diabetic group (35.1%) then the NGR group (27.7%). Both calcified and mixed plaques were found in the coronary arteries of the diabetic group while mixed and non-calcified plaques predominated in the pre-diabetic and the NGR groups. When data from all subjects with CAA were analyzed, blood glucose parameters, fasting plasma glucose (FPG), 2-hr postprandial plasma glucose (PPG), and hemoglobin A1c (HbA1c), exhibited a positive correlation with the severity of coronary stenosis (P<0.05). Multivariable logistic regression models indicated a significantly higher risk of CAA among the diabetic patients. Triglyceride levels were positively correlated with the blood glucose parameters among the three groups while LDL-C was elevated in the DM group but not in the pre-diabetic group compared to the NGR group.
The severity of CAA exhibited a direct correlation with the blood glucose parameters, FPG, PPG, and HbA1c. DSCT can accurately detect the presence and distribution of CAA in asymptomatic, community-dwelling subjects. DSCT is a useful screening tool for coronary artery disease (CAD).
通过双源计算机断层扫描（DSCT）评估随机选取的无症状社区居住中国成年人队列中冠状动脉粥样硬化（CAA）与血糖参数之间的关联。
我们随机选取参与者，并根据其血糖水平将他们分为三组：血糖正常调节（NGR）、糖尿病前期和糖尿病（DM）。参与者接受了DSCT检查，被诊断为CAA的患者根据冠状动脉狭窄的严重程度分为四组。我们根据美国心脏协会（AHA）的指南分析了所有冠状动脉节段中的斑块成分。我们比较了参与者中冠状动脉狭窄的严重程度和斑块成分与血糖参数。
在总共335名参与者中，发现118人患有CAA。糖尿病组中CAA的患病率最高（趋势P值=0.031），为67.7%，其次是糖尿病前期组（35.1%），然后是NGR组（27.7%）。糖尿病组的冠状动脉中发现了钙化斑块和混合斑块，而糖尿病前期组和NGR组中混合斑块和非钙化斑块占主导。当对所有患有CAA的受试者的数据进行分析时，血糖参数、空腹血糖（FPG）、餐后2小时血糖（PPG）和糖化血红蛋白（HbA1c）与冠状动脉狭窄的严重程度呈正相关（P<0.05）。多变量逻辑回归模型表明糖尿病患者发生CAA的风险显著更高。三组中甘油三酯水平与血糖参数呈正相关，与NGR组相比，DM组的低密度脂蛋白胆固醇（LDL-C）升高，而糖尿病前期组未升高。
CAA的严重程度与血糖参数FPG、PPG和HbA1c呈直接相关。DSCT可以准确检测无症状社区居住受试者中CAA的存在和分布。DSCT是一种用于冠状动脉疾病（CAD）的有用筛查工具。
