Risk Factors of Vulnerable Coronary Plaque Formation in Type 2 Diabetes
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摘要: 目的:探讨2型糖尿病(T2DM)冠状动脉易损斑块的相关因素,为临床预测和管理T2DM患者冠脉易损斑块提供重要依据。方法:回顾性分析150例T2DM患者的相关临床指标及冠脉斑块的CT血管造影(CTA)数据,并以是否存在易损斑块分组,探讨T2DM患者冠脉易损斑块形成的独立危险因素,并对相关因素进行ROC曲线分析其诊断效能。结果:甘油三脂(TG)为T2DM患者出现易损斑块的独立危险因素(OR=1.49,95% CI 1.02~2.18);范围内时间(TIR)(OR=0.95,95% CI 0.92~0.97)和高密度脂蛋白(HDL)(OR=0.32,95% CI 0.13~0.78)为独立保护因素。TIR、TG、HDL的曲线下面积(AUC)分别是:0.71、0.69、0.65。联合预测的AUC为0.76,95% CI:0.68~0.83,灵敏度75%,特异度70%。结论:T2DM患者TIR及HDL减低、TG升高时,临床应警惕合并冠脉易损斑块的可能。Abstract: Objective: To explore the related factors of coronary vulnerable plaque in type 2 diabetes (T2DM) and to provide an important basis for clinical prediction and management of coronary vulnerable plaque in patients with T2DM. Methods: A retrospective analysis of 150 patients was performed using T2DM-related clinical indicators and coronary plaque CT angiography (CTA) data, and by the presence of vulnerable plaque groups, to explore the independent risk factors of coronary vulnerable plaque in patients with T2DM and related factors of the ROC curve analysis of its diagnostic efficacy. Results: TG was an independent risk factor for vulnerable plaque in T2DM cases (OR=1.49, 95% CI 1.02~2.18); TIR (OR=0.95, 95% CI 0.92~0.97) and HDL (OR=0.32, 95% CI 0.13~0.78) were independent protection factors. The AUC of TIR, TG, and HDL was 0.71, 0.69, and 0.65, respectively. The AUC for joint prediction was 0.76, 95% CI was 0.68~0.83, sensitivity was 75%, and specificity was 70%. Conclusions: When TIR and HDL decrease and TG increases in patients with T2DM, clinicians should be alert to the possibility of a coronary vulnerable plaque.
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Key words:
- Type 2 diabetes /
- vulnerable plaque /
- CT angiography
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表 1 T2DM冠脉斑块类型与狭窄程度分析
Table 1. Analysis of T2DM coronary plaque types and stenosis degree
斑块类型 狭窄程度 $\chi^2 $ P 轻度 中度 重度 闭塞 非易损斑块(n=83) 50(60.24) 29(34.94) 2(2.41) 2(2.41) 3.95 0.27 易损斑块(n=67) 34(50.75) 26(38.80) 6(8.96) 1(1.49) 总计(n=150) 84(56.00) 55(36.67) 8(5.33) 3(2.00) 表 2 T2DM冠脉易损斑块相关临床指标分析
Table 2. Analysis of clinical indicators related to vulnerable coronary plaque in T2DM
临床因素 总人数(n=150) 非易损斑块(n=83) 易损斑块(n=67) P 男性/% 89(59.33) 49(59.05) 40(59.70) 0.93 年龄/岁 69.5(43,84) 69(43,84) 71(45,82) 0.79 病程/年 9(0.5,23) 10(0.5,20) 8(2,23) 0.27 吸烟/(>20年) 68(45.33) 33 35 0.13 BMI/(kg/m2) 24.8(18.3,28.7) 24.8(18.4,28.3) 25.6(19.5,28.7) 0.87 收缩压/mmHg 137(105.165) 137(105,165) 136±12 0.83 舒张压/mmHg 85(60,101) 83(62,101) 87(60,98) 0.68 HbA1c/% 7.0(4.8,13.8) 6.5(4.8,13.6) 7.8(5.3,13.8) <0.001 TIR/% 59(21,82) 66(23,82) 51±15 <0.001 TBR/% 0(0,33) 0(0,23) 0(0,33) 0.39 TAR/% 39(6,78) 32(13,78) 45(6,77) 0.001 SIRI 0.99(0.12,3.02) 0.99(0.23,2.96) 1.05(0.12,3.02) 0.02 CPR/(mg/L) 7.96(0.22,21.09) 6.9(0.22,17.65) 9.41(0.33,21.09) 0.04 TC/(mmol/L) 4.86±1.24 4.80±1.18 4.93±1.30 0.54 TG/(mmol/L) 2.20(1.23,6.56) 1.91(1.23,6.32) 2.60(1.33,6.56) 0.001 LDL/(mmol/L) 3.00±0.66 3.02±0.68 2.93±0.77 0.37 HDL/(mmol/L) 1.19(0.45,3.65) 1.48±0.27 1.06(0.45,3.65) <0.001 注:BMI-体重指数;HbA1c-糖化血红蛋白;TIR-目标葡萄糖范围内时间;TBR-低于目标葡萄糖范围内时间;TAR-高于目标葡萄糖范围内时间;SIRI-全身炎症反应指数;CPR-C反应蛋白;TC-总胆固醇;TG-甘油三酯;LDL-低密度脂蛋白;HDL-高密度脂蛋白。 表 3 T2 DM易损斑块相关因素的Logistic回归分析
Table 3. Logistic regression analysis of related factors of vulnerable plaque of T2 DM
独立危险因素 B SE Wald P OR值 95% CI TIR -0.05 0.01 16.31 <0.001 0.95 0.92~0.97 TG 0.40 0.19 4.34 0.040 1.49 1.02~2.18 HDL -1.13 0.45 6.28 0.010 0.32 0.13~0.78 常量 3.18 1.10 8.41 0.004 24.05 − -
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