Pan Chang-Jie, Wang Tao, Yin Ruo-Han, Tang Xiao-Qiang, Hu Chun-Hong
Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China.
Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 215006, Jiangsu Province, China.
World J Diabetes. 2025 Apr 15;16(4):99151. doi: 10.4239/wjd.v16.i4.99151.
Coronary heart disease (CHD) is a prevalent type 2 diabetes mellitus (T2DM) complication. Further, the risk stratification before angiography may help diagnose T2DM with CHD early. However, few studies have investigated the coronary imaging characteristics and risk factors of patients with T2DM complicated with CHD.
To compare the differences in coronary imaging between patients with T2DM with and without CHD, determine the risk factors of T2DM complicated with CHD, and establish a predictive tool for diagnosing CHD in T2DM.
This study retrospectively analyzed 103 patients with T2DM from January 2022 to May 2024. They are categorized based on CHD occurrence into: (1) The control group, consisting of patients with T2DM without CHD; and (2) The observation group, which includes patients with T2MD with CHD. Age, sex, smoking and drinking history, CHD family history, metformin (MET) treatment pre-admission, body mass index, fasting blood glucose (FBG), triglyceride (TG), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), serum creatinine, blood urea nitrogen (BUN), alanine aminotransferase, aspartate aminotransferase, glycosylated hemoglobin (HbA1c), and coronary imaging data of both groups were collected from the medical record system. Logistic risk analysis was conducted to screen risk factors. The prediction model's prediction efficiency was evaluated with receiver operating characteristic curves.
The control and observation groups consisted of 48 and 55 cases, respectively. The two groups were statistically different in terms of age ( = 2.006, = 0.048), FBG ( = 6.038, = 0.000), TG ( = 2.015, = 0.047), LDL-C ( = 2.017, = 0.046), and BUN ( = 2.035, = 0.044). The observation group demonstrated lower proportions of patients receiving MET ( = 5.073, = 0.024) and higher proportions of patients with HbA1c of > 7.0% ( = 6.980, = 0.008) than the control group. The observation group consisted of 15, 17, and 23 cases of moderate stenosis, severe stenosis, and occlusion, respectively, with a greater number of coronary artery occlusion cases than the control group ( = 6.399, = 0.041). The observation group consisted significantly higher number of diffuse lesion cases at 35 compared with the control group ( = 15.420, = 0.000). The observation group demonstrated a higher right coronary artery (RCA) stenosis index ( = 6.730, = 0.000), circumflex coronary artery (LCX) stenosis index ( = 5.738, = 0.000), and total stenosis index ( = 7.049, = 0.000) than the control group. FBG [odds ratio (OR) = 1.472; 95% confidence interval (CI): 1.234-1.755; = 0.000] and HbA1c (OR = 3.197; 95%CI: 1.149-8.896; = 0.026) were independent risk factors for T2DM complicated with CHD, whereas MET (OR = 0.350; 95%CI: 0.129-0.952; = 0.040) was considered a protective factor for CHD in T2DM.
Coronary artery occlusion is a prevalent complication in patients with T2DM. Patients with T2MD with CHD demonstrated a higher degree of RCA and LCX stenosis than those with T2DM without CHD. FBG, HbA1c, and MET treatment history are risk factors for T2DM complicated with CHD.
冠心病（CHD）是2型糖尿病（T2DM）的一种常见并发症。此外，血管造影前的风险分层可能有助于早期诊断合并冠心病的T2DM。然而，很少有研究调查合并冠心病的T2DM患者的冠状动脉成像特征和危险因素。
比较合并冠心病和未合并冠心病的T2DM患者的冠状动脉成像差异，确定合并冠心病的T2DM的危险因素，并建立一种诊断T2DM合并冠心病的预测工具。
本研究回顾性分析了2022年1月至2024年5月的103例T2DM患者。根据是否发生冠心病将他们分为：（1）对照组，由未合并冠心病的T2DM患者组成；（2）观察组，包括合并冠心病的T2MD患者。从病历系统中收集两组患者的年龄、性别、吸烟和饮酒史、冠心病家族史、入院前二甲双胍（MET）治疗情况、体重指数、空腹血糖（FBG）、甘油三酯（TG）、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇（LDL-C）、血清肌酐、血尿素氮（BUN）、谷丙转氨酶、谷草转氨酶、糖化血红蛋白（HbA1c）和冠状动脉成像数据。进行逻辑风险分析以筛选危险因素。用受试者工作特征曲线评估预测模型的预测效率。
对照组和观察组分别有48例和55例。两组在年龄（=2.006，=0.048）、FBG（=6.038，=0.000）、TG（=2.015，=0.047）、LDL-C（=2.017，=0.046）和BUN（=2.035，=0.044）方面存在统计学差异。观察组接受MET治疗的患者比例低于对照组（=5.073，=0.024），HbA1c>7.0%的患者比例高于对照组（=6.980，=0.008）。观察组分别有15例、17例和23例中度狭窄、重度狭窄和闭塞病例，冠状动脉闭塞病例数多于对照组（=6.399，=0.041）。观察组35处弥漫性病变病例数明显多于对照组（=15.420，=0.000）。观察组右冠状动脉（RCA）狭窄指数（=6.730，=0.000）、回旋支冠状动脉（LCX）狭窄指数（=5.738，=0.000）和总狭窄指数（=7.049，=0.000）均高于对照组。FBG [比值比（OR）=1.472；95%置信区间（CI）：1.234 - 1.755；=0.000]和HbA1c（OR = 3.197；95%CI：1.149 - 8.896；=0.026）是合并冠心病的T2DM的独立危险因素，而MET（OR = 0.350；95%CI：0.129 - 0.952；=0.040）被认为是T2DM中冠心病的保护因素。
冠状动脉闭塞是T2DM患者的一种常见并发症。合并冠心病的T2MD患者的RCA和LCX狭窄程度高于未合并冠心病的T2DM患者。FBG、HbA1c和MET治疗史是合并冠心病的T2DM的危险因素。
