血糖及HbA1c对冠状动脉粥样硬化影响的影像分析

发布时间：2018-05-29 18:07

本文选题：冠状动脉造影 + 粥样硬化斑块　；参考：《华北理工大学》2017年硕士论文

【摘要】：目的1探讨血糖对冠状动脉粥样硬化患者冠状动脉斑块数目、性质及狭窄程度的影响。2探讨Hb A1c对糖尿病患者冠状动脉斑块性质及狭窄程度的影响。方法1选取2016年3月至6月于华北理工大学附属医院接受256层CT冠状动脉检查的冠状动脉粥样硬化患者171例,根据血糖水平分为三组,Ⅰ组(无血糖异常,n=82)、Ⅱ组(葡萄糖调节受损IGR,n=30)、Ⅲ组(2型糖尿病T2DM,n=59)。记录每位患者的一般资料(性别、年龄、体重指数、高胆固醇血症、高血压及吸烟史),分别统计每条血管的钙化斑块、非钙化斑块及混合斑块的数目,并统计每条血管的狭窄程度。分别比较三组患者粥样硬化斑块的数目、不同性质斑块及冠状动脉不同狭窄程度的检出情况。2选取2016年5月至9月于华北理工大学附属医院接受256层CT冠状动脉检查的糖尿病患者108例,根据Hb A1c水平分为两组,Ⅰ组(伴二型糖尿病(T2DM),Hb A1c8.0%,(血糖控制一般)n=56),Ⅱ组(伴T2DM,Hb A1c≥8.0%,(血糖控制不好)n=52)。记录每位患者的一般资料(性别、年龄、体重指数、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、高血压及吸烟史),分别统计每条血管的钙化斑块、非钙化斑块及混合斑块的数目,并统计每条血管的狭窄程度。分别比较两组患者不同性质斑块及冠状动脉不同狭窄程度的检出情况结果1无血糖异常组、伴IGR组、伴T2DM组,发现粥样硬化斑块的数目分别为201个、123个及252个,平均斑块数分别为2.48±0.94个、4.10±2.02个及4.27±1.85个,三组相比,差异有统计学意义(F=27.357,P=0.000,P0.05)。IGR组与T2DM组平均斑块数相比,差异无统计学意义(P=0.619,P0.05)。无血糖异常组钙化斑块、非钙化斑块及混合斑块的检出率分别为60.7%、15.4%及23.9%,伴IGR组钙化斑块、非钙化斑块及混合斑块的检出率分别为44.7%、22.0%及33.3%,伴T2DM组钙化斑块、非钙化斑块及混合斑块的检出率分别为34.5%、28.6%及36.9%,三组相比,差异有统计学意义(χ2=31.498,P=0.000,P0.05)。无血糖异常组与IGR组,无血糖异常组与T2DM组,各类斑块的检出率相比,差异具有统计学意义(χ2=7.886,P=0.020;χ2=31.197,P=0.00)。IGR组与T2DM组,各类斑块检出率相比,差异无统计学意义(χ2=3.935,P=0.140)。无血糖异常组轻度狭窄、中度狭窄及重度狭窄的检出率分别为66.5%、21.3%及12.2%,伴IGR组轻度狭窄、中度狭窄及重度狭窄的检出率分别为23.0%、35.1%及41.9%,伴T2DM组轻度狭窄、中度狭窄及重度狭窄的检出率分别为21.0%、35.6%及43.4%。三组相比,差异有统计学意义(χ2=83.421,P=0.000,P0.05)。无血糖异常组与IGR组、无血糖异常组与T2DM组冠状动脉狭窄程度检出率差异有统计学意义(Z=㧟6.462,P=0.000,P0.05;Z=㧟8.719,P=0.000,P0.05)。IGR组与T2DM组冠状动脉狭窄程度检出率差异无统计学意义(Z=㧟0.320,P=0.749,P0.05)。2伴T2DM血糖控制一般组钙化斑块、非钙化斑块及混合斑块的发生率分别为56.7%、20.1%及23.2%,伴T2DM血糖控制不好组钙化斑块、非钙化斑块及混合斑块的发生率分别为30.9%、31.3%及37.8%,两组相比,差异有统计学意义(χ2=27.886,P=0.000,P0.05)。伴T2DM血糖控制一般组轻度狭窄、中度狭窄及重度狭窄的检出率分别为52.8%、30.8%及16.4%,伴T2DM血糖控制不好组轻度狭窄、中度狭窄及重度狭窄的检出率分别为24.7%、40.4%及34.9%,两组相比,差异有统计学意义(Z=㧟5.365,P=0.001,P0.05)。结论1与血糖正常者相比,血糖异常者冠状动脉粥样硬化斑块数目增多,混合斑块及非钙化斑块的检出率升高,钙化斑块的检出率降低,冠状动脉狭窄程度加重。2糖代谢异常者与糖尿病患者相比,其冠状动脉病变程度相似。3糖尿病患者,随着Hb A1c水平的升高,冠状动脉混合斑块及非钙化斑块的检出率升高,钙化斑块的检出率降低,冠状动脉狭窄程度加重。
[Abstract]:Objective 1 to investigate the influence of blood glucose on the number, nature and stenosis of coronary atherosclerotic plaque in patients with coronary atherosclerosis..2 explore the effect of Hb A1c on the coronary plaque properties and stenosis of diabetic patients. Method 1 select the coronary artery from March 2016 to June in the Affiliated Hospital of North China Polytechnic University for 256 layers of coronary artery examination. 171 patients with atherosclerosis were divided into three groups according to the blood glucose level, group I (abnormal blood glucose, n=82), group II (impaired glucose regulation IGR, n=30), group III (type 2 diabetes T2DM, n=59). Record the general data of each patient (sex, age, body mass index, hypercholesterolemia, hypertension, and smoking history), respectively, to count the calcified plaque in each vessel, respectively. The number of non calcified plaques and mixed plaques and the degree of stenosis of each vessel were compared. The number of atherosclerotic plaques in three groups, the detection of different types of atherosclerotic plaques and the degree of coronary stenosis, respectively,.2 were selected from May 2016 to September at the Affiliated Hospital of North China Polytechnic University to receive 256 layers of diabetes mellitus with coronary artery disease. 108 patients were divided into two groups according to the Hb A1c level, group I (T2DM), Hb A1c8.0%, n=56), group II (T2DM, Hb A1c > 8%, and poor control of blood glucose) n=52). Record the general data of each patient (sex, age, body mass index, total cholesterol (TC), three acyl glycerol (TG), high-density lipoprotein, low density fat Protein (LDL), hypertension and smoking history), statistics of each vascular calcified plaque, the number of non calcified plaque and mixed plaque, and statistics of the degree of stenosis in each vessel. Comparison of two groups of patients with different properties of plaque and the degree of coronary artery stenosis were compared with 1 blood sugar abnormality group, group IGR, and T2DM group, found congee The number of sclerosing plaques were 201, 123 and 252, and the average plaque number was 2.48 + 0.94, 4.10 + 2.02 and 4.27 + 1.85. The difference was statistically significant (F=27.357, P=0.000, P0.05).IGR group compared with the average plaque number in T2DM group (P=0.619, P0.05). The detection rates of calcified plaque and mixed plaque were 60.7%, 15.4% and 23.9%, with IGR group calcified plaque. The detection rates of non calcified plaques and mixed plaques were 44.7%, 22% and 33.3% respectively, with T2DM group calcified plaque, and the detection rates of non calcified plaques and mixed plaques were 34.5%, 28.6% and 36.9%, respectively, and the difference was statistically significant (2=31). .498, P=0.000, P0.05). The difference between the blood sugar abnormality group and the group IGR, the blood glucose free group and the T2DM group, the detection rates of all kinds of plaques, the difference was statistically significant (x 2=7.886, P=0.020; Chi 2=31.197, P=0.00).IGR group and T2DM group, the difference was not statistically significant (x 2=3.935, moderate). The detection rates of narrow and severe stenosis were 66.5%, 21.3% and 12.2%, with mild stenosis in group IGR, moderate stenosis and severe stenosis in 23%, 35.1% and 41.9%, with mild stenosis in group T2DM, and 21%, 35.6% and 43.4 of moderate stenosis and severe stenosis respectively. The difference was statistically significant (x 2=83.421, P=0.000). P0.05). There was a significant difference in the detection rate of coronary artery stenosis between the abnormal glycemic group and the IGR group (Z=? 6.462, P=0.000, P0.05; Z=? 8.719, P=0.000, P0.05); there was no significant difference in the detection rate of coronary stenosis in.IGR and T2DM group (Z=? 0.320) The incidence of plaque, non calcified plaque and mixed plaque were 56.7%, 20.1% and 23.2%, respectively, with T2DM blood glucose control group calcified plaque, the incidence of non calcified plaques and mixed plaques were 30.9%, 31.3% and 37.8% respectively, two groups were statistically significant (x 2= 27.886, P=0.000, P0.05). With T2DM blood glucose control general mild stenosis, The detectable rates of moderate and severe stenosis were 52.8%, 30.8% and 16.4% respectively, with mild stenosis in poor T2DM control group and 24.7% for moderate and severe stenosis, 40.4% and 34.9% respectively. The difference was statistically significant (Z=? 5.365, P=0.001, P0.05) in two groups. Conclusion 1 compared with normal blood glucose, patients with abnormal blood glucose, coronary artery The number of atherosclerotic plaques increased, the detection rate of mixed plaque and non calcified plaque increased, the detection rate of calcified plaque decreased, and the degree of coronary artery stenosis aggravated.2 glucose metabolism. Compared with diabetic patients, the degree of coronary artery disease was similar to that of.3 diabetic patients. With the increase of Hb A1c level, coronary artery mixed plaque and non calcium. The detection rate of atherosclerotic plaque increased, the detection rate of calcified plaque decreased, and the degree of coronary artery stenosis increased.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4;R816.2

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