2型糖尿病患者下肢动脉病变预测无症状冠心病的临床价值研究
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摘要
目的探讨T2DM患者下肢动脉病变(PAD)与无症状冠心病(CAD)患病风险的关系及预测价值。方法 365例无CAD病史且无胸闷、胸痛等CAD症状的T2DM患者为研究对象,按照下肢动脉彩超任一节段狭窄率≥50%或闭塞分为下肢动脉病变(PAD,n=63)组和非PAD组(n=302),根据冠状动脉(下称"冠脉")血管造影检查有1支或1支以上冠脉狭窄≥50%定义为无症状CAD。结果 PAD总检出率为17.3%(63/365),PAD组年龄、SBP、高血压病、吸烟史、入院前降压药及他汀类药物使用、无症状CAD患病率均高于非PAD组(P<0.05或P<0.01)。Logistics回归分析结果显示,校正年龄、性别、吸烟、血压、血糖、血脂、eGFR、口服ACEI/ARB类降压药物和他汀类降脂药百分比等混杂因素后,PAD为T2DM患者无症状CAD的独立危险因素,OR(95%CI)为2.177(1.117~4.243)(P<0.05)。PAD组中冠脉单支≥50%的发生率低于非PAD组,但3支冠脉病变≥50%的发生率高于非PAD组(P<0.01)。两组双支冠脉病变≥50%的发生率比较,差异无统计学意义(P>0.05)。结论 T2DM患者合并PAD时无症状CAD的患病风险增加,且冠脉3支病变更多见。
Objective To investigate the association of peripheral artery disease(PAD)and asymptomatic coronary artery disease(CAD)in type 2 diabetic patients(T2DM)and its predictive value.Methods A total of 365 T2DM who had no CAD history and no symptoms such as chest tightness and chest pain were enrolled.According to the stenosis rate of≥50% or occlusion of any segment of vascular ultrasound,they were divided into PAD group and non-PAD group.Based on the findings of the coronary CTA angiography,patients with one or more coronary artery stenosis ≥ 50% were defined as asymptomatic CAD. Results The detection rate of PAD in hospitalized T2DM patients was 17.3%(63/365).The age,SBP hypertension history,the proportion of smoking,the use of statins and antihypertensive drugs and the rate of asymptomatic CAD were higher in PAD group than those in the non PAD group(P<0.05 or P<0.01).Logistics regression analysis showed that the presence of PAD was an independent risk factor for asymptomatic CAD in patients with T2DM after adjusting for age,gender,smoking,blood pressure,blood glucose,blood lipids,eGFR,ACEI/ARB and statin use[OR(95% CI)2.177(1.117~4.243)](P<0.05).In PAD group,the incidence of single coronary stenosis was lower than that in the non-PAD group,but the incidence of three coronary lesions was higher than that in the non-PAD group(P<0.01).There was no significant difference in the incidence of two coronary lesions≥50% between the two groups(P>0.05). Conclusion T2DM patients with PAD have an increased risk of asymptomatic CAD and often present with three coronary lesions.
Objective To investigate the association of peripheral artery disease(PAD)and asymptomatic coronary artery disease(CAD)in type 2 diabetic patients(T2DM)and its predictive value.Methods A total of 365 T2DM who had no CAD history and no symptoms such as chest tightness and chest pain were enrolled.According to the stenosis rate of≥50% or occlusion of any segment of vascular ultrasound,they were divided into PAD group and non-PAD group.Based on the findings of the coronary CTA angiography,patients with one or more coronary artery stenosis ≥ 50% were defined as asymptomatic CAD. Results The detection rate of PAD in hospitalized T2DM patients was 17.3%(63/365).The age,SBP hypertension history,the proportion of smoking,the use of statins and antihypertensive drugs and the rate of asymptomatic CAD were higher in PAD group than those in the non PAD group(P<0.05 or P<0.01).Logistics regression analysis showed that the presence of PAD was an independent risk factor for asymptomatic CAD in patients with T2DM after adjusting for age,gender,smoking,blood pressure,blood glucose,blood lipids,eGFR,ACEI/ARB and statin use[OR(95% CI)2.177(1.117~4.243)](P<0.05).In PAD group,the incidence of single coronary stenosis was lower than that in the non-PAD group,but the incidence of three coronary lesions was higher than that in the non-PAD group(P<0.01).There was no significant difference in the incidence of two coronary lesions≥50% between the two groups(P>0.05). Conclusion T2DM patients with PAD have an increased risk of asymptomatic CAD and often present with three coronary lesions.
引文
[1]刘珊,周翔海,胡萍,等.2型糖尿病患者颈动脉和下肢动脉粥样硬化分级与心脑血管疾病关系的研究.中华内分泌代谢杂志,2016,32:989-994.
[2]Xu Y,Bi Y,Li M,et al.Significant coronary stenosis in asymptomatic Chinese with different glycemic status.Diabetes Care,2013,36:1687-1694.
[3]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心血管病预防指南.中华心血管病杂志,2011,39:3-22.
[4]王莉,杨彩哲,王良宸,等.糖尿病下肢血管病变的相关因素分析.解放军医学杂志,2014,39:507-509.
[5]Wilkinson CP,Ferris FL,Klein RE,et al.Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales.Ophthalmology,2003,110:1677-1682.
[6]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版).中华糖尿病杂志,2018,10:4-67.
[7]World Health Organization.Guidelines for controlling and monitoring the tobacco epidemic.World Health Organization,1998.
[8]万倩,张倩,钱毅,等.肾小球滤过率评估方程在2型糖尿病患者中的应用.中国糖尿病杂志,2014,22:799-803.
[9]Nam SC,Han SH,Hong YS,et al.Factors affecting the validity of ankle-brachialIndex in the diagnosis of peripheral arterial obstructive disease.Angiology,2009,61:392-396.
[10]贾睿博,詹晓蓉.2型糖尿病下肢血管病变研究进展.中华临床医师杂志:电子版,2013,22:111.
[11]中华医学会外科分会血管外科学组.下肢动脉硬化闭塞症诊治指南.中华医学杂志,2015,95:1883-1896.
[12]崔艳玲,王广志,周茂义,等.64MDCT冠状动脉成像对隐匿性冠心病的诊断价值.医学影像学杂志,2009,11:1405-1408.
[13]Sarwar N,Gao P,Seshasai SR,et al.Diabetes mellitus,fasting blood glucose concentration,and risk ofvascular disease:Acollaborative meta-analysis of 102prospective studies.Lancet,2010,375:2215-2222.
[14]Steg PG,Bhatt DL,Wilson PW,et al.One-year cardiovascular event rates in outpatients with atherothrombosis.JAMA,2007,297:1197-1206.
[15]Fowkes FG,Murray GD,Butcher I,et al.Ankle brachial index combined with framingham risk score to predict cardiovascular events and mortality:A meta-analysis.JAMA,2008,300:197-208.
[16]Agarwal AK,Manjeet S,Vivek A,et al.Prevalence of peripheral arterial disease in type 2diabetes mellitus and its correlation with coronary artery disease and its risk factors.J Ass Phys Ind,2012,60:28-32.
[17]Kim EK,Song PS,Yang JH,et al.Peripheral artery disease in korean patients undergoing percutaneous coronary intervention:Prevalence and association with coronary artery disease severity.J Kor Med Sci,2013,28:87-92.
[18]Papa EDE,Helber I,Ehrlichmann MR,et al.Ankle-brachial index as a predictor of coronary disease events in elderly patients submitted to coronary angiography.Clinics,2013,68:1481-1487.
[2]Xu Y,Bi Y,Li M,et al.Significant coronary stenosis in asymptomatic Chinese with different glycemic status.Diabetes Care,2013,36:1687-1694.
[3]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心血管病预防指南.中华心血管病杂志,2011,39:3-22.
[4]王莉,杨彩哲,王良宸,等.糖尿病下肢血管病变的相关因素分析.解放军医学杂志,2014,39:507-509.
[5]Wilkinson CP,Ferris FL,Klein RE,et al.Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales.Ophthalmology,2003,110:1677-1682.
[6]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版).中华糖尿病杂志,2018,10:4-67.
[7]World Health Organization.Guidelines for controlling and monitoring the tobacco epidemic.World Health Organization,1998.
[8]万倩,张倩,钱毅,等.肾小球滤过率评估方程在2型糖尿病患者中的应用.中国糖尿病杂志,2014,22:799-803.
[9]Nam SC,Han SH,Hong YS,et al.Factors affecting the validity of ankle-brachialIndex in the diagnosis of peripheral arterial obstructive disease.Angiology,2009,61:392-396.
[10]贾睿博,詹晓蓉.2型糖尿病下肢血管病变研究进展.中华临床医师杂志:电子版,2013,22:111.
[11]中华医学会外科分会血管外科学组.下肢动脉硬化闭塞症诊治指南.中华医学杂志,2015,95:1883-1896.
[12]崔艳玲,王广志,周茂义,等.64MDCT冠状动脉成像对隐匿性冠心病的诊断价值.医学影像学杂志,2009,11:1405-1408.
[13]Sarwar N,Gao P,Seshasai SR,et al.Diabetes mellitus,fasting blood glucose concentration,and risk ofvascular disease:Acollaborative meta-analysis of 102prospective studies.Lancet,2010,375:2215-2222.
[14]Steg PG,Bhatt DL,Wilson PW,et al.One-year cardiovascular event rates in outpatients with atherothrombosis.JAMA,2007,297:1197-1206.
[15]Fowkes FG,Murray GD,Butcher I,et al.Ankle brachial index combined with framingham risk score to predict cardiovascular events and mortality:A meta-analysis.JAMA,2008,300:197-208.
[16]Agarwal AK,Manjeet S,Vivek A,et al.Prevalence of peripheral arterial disease in type 2diabetes mellitus and its correlation with coronary artery disease and its risk factors.J Ass Phys Ind,2012,60:28-32.
[17]Kim EK,Song PS,Yang JH,et al.Peripheral artery disease in korean patients undergoing percutaneous coronary intervention:Prevalence and association with coronary artery disease severity.J Kor Med Sci,2013,28:87-92.
[18]Papa EDE,Helber I,Ehrlichmann MR,et al.Ankle-brachial index as a predictor of coronary disease events in elderly patients submitted to coronary angiography.Clinics,2013,68:1481-1487.