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目的利用血管内超声检测糖尿病患者与非糖尿病患者左冠状动脉主干部(左主干),阐述两者冠状动脉粥样硬化病变的特点。方法冠心病患者129例,其中合并糖尿病史40例,无糖尿病史89例。所有患者在进行左冠状动脉系统的介入检查和治疗时,给予左主干的血管内超声检查,并在每间隔1mm的超声断面上测量血管外腔面积、内腔面积、斑块面积以及钙化角度,然后将所有检测断面的相应数值相加,从而得到整个左主干的外腔容积、内腔容积、斑块体积和总的钙化负荷,最后比较各检测数据在合并糖尿病组和无糖尿病组的差别。结果不论在最小内腔面积的血管断面还是在整个左主干,血管内外腔和斑块大小在两组之间的差别无统计学意义,但糖尿病组的钙化阳性率明显高于非糖尿病组(67.5%对44.9%,P=0.022);定量测量最小内腔面积的血管断面上总钙化角度,糖尿病组显著高于非糖尿病组(P=0.027);整个左主干总的钙负荷,糖尿病组显著高于非糖尿病组。结论糖尿病患者与非糖尿病患者相比,即使左主干的内外径和斑块的大小不存在差异,管壁的钙化情况和斑块的构成却显著不同,前者钙化出现的阳性率和钙化程度均明显高于后者。
Objective To detect the characteristics of coronary atherosclerotic lesion in the left main coronary artery (left main trunk) of diabetic patients and non-diabetic patients by intravascular ultrasound. Methods 129 cases of coronary heart disease patients, including 40 cases of history of diabetes mellitus, 89 cases without history of diabetes. All patients underwent left ventricular endocardial ultrasonography during interventional examination and treatment of the left coronary artery system. The external vascular area, internal luminal area, plaque area and calcification angle were measured on every 1 mm ultrasound section. Then, the corresponding values of all the test sections were added to get the volume of the external cavity, lumen volume, plaque volume and total calcification load of the left main trunk. Finally, the differences of the test data between the diabetic group and the non-diabetic group were compared. Results No significant difference was found between the two groups in vascular cross-section of the minimal lumen area or in the entire left main trunk. The positive rates of calcification in the diabetic group were significantly higher than those in the non-diabetic group (67.5 % Versus 44.9%, P = 0.022). The total calcification in the vascular section with the smallest lumen area was significantly higher in the diabetic group than in the non-diabetic group (P = 0.027). The total left cadmineous calcium load was significantly higher in the diabetic group In non-diabetic group. Conclusion Compared with non-diabetic patients, even though there is no difference in the diameter of the left main trunk and the size of the plaque, the calcification of the wall and the plaque formation are significantly different, the positive rate of calcification and the degree of calcification in the former are obvious Higher than the latter.