| 朱鸿燕,宗珍,高枫.颈动脉最大斑块高度而非颈动脉内中膜厚度是糖尿病患者严重冠状动脉疾病预测指标[J].浙江中西医结合杂志,2025,35(1): |
| 颈动脉最大斑块高度而非颈动脉内中膜厚度是糖尿病患者严重冠状动脉疾病预测指标 |
| Carotid maximum plaque height but not carotid intima-media thickness is a predictor of severe coronary artery disease in diabetic patients |
| 投稿时间：2024-04-02 修订日期：2024-09-07 |
| DOI： |
| 中文关键词: 颈动脉最大斑块高度 严重冠状动脉疾病 糖尿病 预测 |
| 英文关键词:Carotid maximum plaque height severe coronary artery disease diabetes mellitus prediction |
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| 中文摘要: |
| 摘要 目的 在糖尿病患者中,关于颈动脉最大斑块高度(MPH)与严重冠状动脉疾病(CAD)之间关系的数据还较少,本研究旨在评估MPH对严重CAD的预测价值? 方法 我们回顾研究了115名连续接受冠状动脉造影和颈动脉超声检查的糖尿病患者,并测量了颈动脉斑块超声参数,颈动脉内中膜厚度(CIMT)?MPH?最大斑块长度(max-CPL)?颈动脉狭窄率?收缩期峰值速度?最大阻力指数?斑块回声,根据冠状动脉主要分支的任何一段≥70%狭窄或左冠状动脉主干≥50%狭窄为严重CAD,其余为非严重CAD,比较两组差异,采用多因素回归分析来确定独立预测因素，并绘制受试者工作特征 (ROC) 曲线分析其预测严重CAD的敏感度、特异度。结果 78例糖尿病患者有严重CAD,严重CAD患者的MPH比非严重CAD大(P = 0.005)?性别?血脂异常?吸烟?CIMT?MPH和max-CPL均是预测严重CAD的显著因素(P<0.05)?多因素Logistic回归分析发现,血脂异常?吸烟?MPH是严重CAD独立预测因素?与MPH(AUC = 0.66)相比,血脂异常和吸烟对严重CAD的预测值相对较低(AUC分别为0.63?0.64),联合临床和超声的AUC提高到0.78,此时阈值0.63? 结论 糖尿病患者中MPH为严重CAD提供了独立预测价值,是预测严重CAD中一个简单有用的标志物,而且联合吸烟和血脂异常可以提高预测严重CAD的能力? |
| 英文摘要: |
| Abstract: Objctive In patients with diabetes mellitus, there are fewer data on the relationship between carotid maximum plaque height (MPH) and severe coronary artery disease (CAD), and the aim of this study was to evaluate the predictive value of MPH for severe CAD. Methods We retrospectively studied 115 consecutive diabetic patients who underwent coronary angiography and carotid ultrasound, and measured carotid plaque ultrasound parameters, carotid intima-media thickness (CIMT), MPH, maximum carotid plaque length (max-CPL), carotid artery stenosis rate, peak systolic velocity, maximum artery resistance index, and plaque echogenicity. According to ≥70% narrowing within any segment of the main branches of the coronary artery or ≥50% in the left main coronary artery was considered as severe CAD, and the rest was considered as non-severe CAD. Comparing the two groups, multivariate logistic regression analysis was used to determine independent predictors, and the sensitivity and specificity of predicting severe CAD were analyzed by plotting receiver operating characteristic (ROC) curves. Results Seventy-eight diabetic patients had severe CAD, and the MPH of patients with severe CAD was greater than that of those with non-severe CAD (P = 0.005). Gender, dyslipidemia, smoking, CIMT, MPH, and max-CPL were significant predictors of severe CAD (P < 0.05). Multivariate logistic regression analysis revealed that dyslipidemia, smoking, and MPH were independent predictors for severe CAD. Compared with MPH (AUC = 0.66), dyslipidemia and smoking had relatively low predictive values for severe CAD (AUC = 0.63 and AUC = 0.64, respectively), and the AUC of combined clinical and ultrasound increased to 0.78, and the cutoff value was 0.63. Conclusions MPH in diabetic patients provides independent predictive value for severe CAD, and is a simple and useful marker for predicting severe CAD. Moreover, combining smoking and dyslipidemia can improve the prediction performance of severe CAD. |
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