血糖波动对糖代谢异常患者冠状动脉斑块易损性的影响：采用多层 CT 进行的全冠状动脉分析。
Impact of glucose variability on coronary plaque vulnerability in patients with dysglycemia: A whole coronary analysis with multislice computed tomography.
机构信息
Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya 4678601, Japan.
Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya 4678601, Japan.
出版信息
J Cardiol. 2022 Jan;79(1):58-64. doi: 10.1016/j.jjcc.2021.08.001. Epub 2021 Aug 16.
BACKGROUND
Dysglycemia is associated with an increased risk of acute coronary syndrome caused by the disruption of vulnerable plaques. The relationship between glycemic variability (GV), which is a component of impaired glucose metabolism, and coronary plaque vulnerability has not been fully elucidated. This study investigated the impact of GV on whole coronary plaque vulnerability using multislice computed tomography (MSCT).
METHODS
We analyzed 88 patients with dysglycemia who underwent 24 h blood glucose monitoring and MSCT. The mean amplitude of glycemic excursion (MAGE) was calculated as an index of the GV. We defined a CT-derived vulnerable plaque as a plaque with a remodeling index > 1.10 and a mean CT density < 30 HU. We calculated the percentage of low-attenuation plaque (% LAP) as the ratio of the low-attenuation component (CT density < 30HU) volume to the total vessel volume.
RESULTS
Vulnerable plaques were detected in 27 patients (31%). Patients with vulnerable plaques had higher MAGE (110.0 ± 40.7 vs. 71.7 ± 21.7, p < 0.01) than patients without vulnerable plaques. A univariate logistic regression analysis showed that vulnerable plaques were associated with the MAGE [odds ratio (OR) 1.04, 95% confidence interval (CI), 1.02-1.07, p < 0.01]. In a multivariate model, the MAGE (OR 1.05, 95% CI 1.02-1.07) remained a significant predictor of vulnerable plaque presence. Patients with multivessel-vulnerable plaques had higher MAGE values than those with single-vessel involvement or no vulnerable plaques (132.3 ± 39.4 vs. 102.2 ± 39.7, vs. 71.7 ± 21.7, p < 0.01). The regression analysis showed a positive correlation between MAGE levels and the % LAP (r = 0.55, p < 0.01). In a multiple linear regression analysis, the MAGE was independently associated with the % LAP (β = 0.42, p < 0.01).
CONCLUSIONS
Increased GV is associated with the presence and extent of vulnerable plaques.
背景
糖代谢紊乱与易损斑块破裂导致的急性冠状动脉综合征风险增加有关。血糖变异性（GV）是葡萄糖代谢受损的一个组成部分，其与冠状动脉斑块易损性之间的关系尚未完全阐明。本研究使用多层螺旋 CT（MSCT）探讨了 GV 对全冠状动脉斑块易损性的影响。
方法
我们分析了 88 例患有糖代谢紊乱的患者，这些患者接受了 24 小时血糖监测和 MSCT 检查。平均血糖波动幅度（MAGE）被计算为 GV 的指标。我们将 CT 检测到的易损斑块定义为重构指数>1.10 且平均 CT 密度<30 HU 的斑块。我们将低衰减斑块百分比（% LAP）计算为低衰减成分（CT 密度<30 HU）体积与总血管体积的比值。
结果
在 27 例患者（31%）中发现了易损斑块。与无易损斑块的患者相比，有易损斑块的患者的 MAGE 更高（110.0±40.7 比 71.7±21.7，p<0.01）。单因素 logistic 回归分析显示，易损斑块与 MAGE 相关[比值比（OR）1.04，95%置信区间（CI）1.02-1.07，p<0.01]。在多变量模型中，MAGE（OR 1.05，95%CI 1.02-1.07）仍然是易损斑块存在的显著预测因子。多支血管易损斑块患者的 MAGE 值高于单支血管受累或无易损斑块的患者（132.3±39.4 比 102.2±39.7 比 71.7±21.7，p<0.01）。回归分析显示 MAGE 水平与% LAP 呈正相关（r=0.55，p<0.01）。在多元线性回归分析中，MAGE 与% LAP 独立相关（β=0.42，p<0.01）。
结论
血糖变异性增加与易损斑块的存在和严重程度有关。
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