颈动脉超声检查对糖尿病合并冠心病患者的应用价值研究
|
摘要
目的探讨颈动脉超声检查对糖尿病合并冠心病患者的应用价值。方法选择2016年10月—2017年10月我院收治的初诊冠心病患者181例,根据是否合并2型糖尿病分为观察组79例,对照组102例。对2组的血压、血脂、糖化血红蛋白、冠脉造影结果及颈动脉超声结果进行分析,观察Gensini积分与Crouse、CA积分和斑块个数的相关性。结果 2组血压、胆固醇、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇比较差异无统计学意义(P>0.05),观察组甘油三酯、糖化血红蛋白水平高于对照组(P<0.05)。观察组Gensini积分、3支病变、弥漫性病变发生率均高于对照组(P<0.05)。观察组CA积分、Crouse积分、斑块个数均高于对照组,(P<0.05)。Gensini积分与Crouse、CA积分和斑块个数呈正相关(r=0.25、0.36、0.27,P<0.01)。结论对于冠心病的高危人群,尤其是2型糖尿病患者,可通过颈动脉超声进行筛查,以达到早期诊断,早期控制疾病进展及提高治疗效率的目的。
Objective To investigate value of carotid ultrasonography in application of patients with diabetes mellitus complicated by coronary heart disease. Methods A total of 181 patients with coronary heart disease by preliminary diagnosis admitted during October 2016 and October 2017 were divided into observation group(n=79) and control group(n=102) according to whether or not combination of type 2 diabetes mellitus. In two groups, levels of blood pressure, blood lipid, glycosylated hemoglobin, coronary angiography and carotid artery ultrasound results were analyzed, and correlations among Gensini score with Rouse and CA scores and plaque number were observed. Results There were no significant differences in blood pressure, cholesterol, high density lipoprotein cholesterol or low density lipoprotein cholesterol between two groups(P>0.05). In observation group, levels of triglyceride and glycosylated hemoglobin were significantly higher(P<0.05); Gensini score, incidence rates of three vessel lesions and diffuse lesions were significantly higher(P<0.05); CA score, Crouse score and plaques number were significantly higher than those in control group(P<0.05). Gensini score was positively correlated with Crouse score, CA score and plaques number(r=0.25, 0.36, 0.27, P<0.01). Conclusion Screening by carotid ultrasound can be used for high-risk patients with coronary heart disease, especially for patients with type 2 diabetes mellitus in order to early diagnosis, early control of disease progress and improve treatment efficiency.
Objective To investigate value of carotid ultrasonography in application of patients with diabetes mellitus complicated by coronary heart disease. Methods A total of 181 patients with coronary heart disease by preliminary diagnosis admitted during October 2016 and October 2017 were divided into observation group(n=79) and control group(n=102) according to whether or not combination of type 2 diabetes mellitus. In two groups, levels of blood pressure, blood lipid, glycosylated hemoglobin, coronary angiography and carotid artery ultrasound results were analyzed, and correlations among Gensini score with Rouse and CA scores and plaque number were observed. Results There were no significant differences in blood pressure, cholesterol, high density lipoprotein cholesterol or low density lipoprotein cholesterol between two groups(P>0.05). In observation group, levels of triglyceride and glycosylated hemoglobin were significantly higher(P<0.05); Gensini score, incidence rates of three vessel lesions and diffuse lesions were significantly higher(P<0.05); CA score, Crouse score and plaques number were significantly higher than those in control group(P<0.05). Gensini score was positively correlated with Crouse score, CA score and plaques number(r=0.25, 0.36, 0.27, P<0.01). Conclusion Screening by carotid ultrasound can be used for high-risk patients with coronary heart disease, especially for patients with type 2 diabetes mellitus in order to early diagnosis, early control of disease progress and improve treatment efficiency.
引文
[1] 王先令,陆菊明.血糖波动对糖尿病预后及其慢性并发症发生发展的影响[J]国外医学:内分泌学分册,2005,25(3):169-173.
[2] 赵克强,吴巍巍,赵俊来,等.颈动脉狭窄合并糖尿病患者行颈动脉内膜剥脱术的疗效分析[J].中华医学杂志,2015,95(44):3584-3587.
[3] 房振,宋书凯,李敬田.2型糖尿病合并冠心病患者血浆hs-CRP、IL-6与颈动脉内中膜厚度的相关性[J].山东医药,2016,56(14):50-52.
[4] 何雁,李小晶,彭红艳,等.超声造影时间-强度曲线评价颈动脉粥样硬化斑块稳定性与2型糖尿病并发冠心病的相关性[J].实用医学杂志,2016,32(4):600-603.
[5] Bowden D W,Cox A J.Diabetes:Unravelling the enigma of T2DM and cardiovascular disease[J].Nat Rev Endocrinol,2013,9(11):632-633.
[6] 徐向进,潘长玉,田慧,等.WHO及美国糖尿病学会糖尿病诊断标准在老年人群中应用的分析和评估[J]中华内分泌代谢杂志,2002,18(5):27-31.
[7] Kablak-ziembicka A,Przewlocki T,Stepien E,et al.Relationship between carotid intima-media thickness,cytokines,atherosclerosis extent and a two year cardiovascular risk in patients with rteriosclerosis[J].Kardiol Pol J,2011,69(10):1024-1031.
[8] 王巧凤,周晓芳.甘油三酯与心血管剩留风险[J].实用医院临床杂志,2013,10(5):257-259.
[9] 汇波,武越,许文亮,等.颈动脉超声检查评价糖尿病患者冠状动脉粥样硬化的意义[J].临床荟萃,2013.28(12):1402-1404.
[10] 黎艳,李莉,余枫.2型糖尿病患者趾臂指数和踝臂指数与颈动脉粥样硬化性狭窄的相关性[J].广东医学,2013,34(2):253-255.
[11] 高明杰,华扬,贾凌云.2型糖尿病患者颅内、颈部、下肢动脉粥样硬化性病变的超声研究[J].中华医学超声杂志:电子版,2010,7(10):1691-1698.
[12] 刘梅.冠心病患者颈动脉超声检查的特征[J].心血管康复医学杂志,2011,20(4):110 - 112.
[13] 姜涛,宋秀霞,张敏.2型糖尿病颈动脉内膜中膜厚度与胰岛素抵抗的关系[J].中华糖尿病杂志,2005,13(4):260 - 261.
[14] 朱玲,吴琳娜,曾忠仪,等.2型糖尿病合并冠心病患者颈动脉狭窄的筛查价值[J].成都医学院学报,2018,13(2):169-172
[15] 陈绚,李国辉,黄云旗,等.颈动脉超声应用筛查颈动脉狭窄及脑卒中高危因素分析[J].国际神经病学神经外科学杂志,2016,43(4):302-305
[16] 孙秀芹,包柄楠,赵怡,等.行冠状动脉重建术的糖尿病与非糖尿病患者颈动脉病变特点研究[J].中国全科医学,2017,20(13):1597-1600.
[17] 贾晓东,潘晓芳.颈动脉超声在筛查颈动脉狭窄及脑卒中高危人群中的应用[J].中国现代药物应用,2015,9(19):40-41.
[18] 任全刚,崔春燕,刘岳峰.脑梗死患者颈动脉彩超诊断颈动脉粥样硬化的临床价值分析[J].北京医学,2015,37(7):716-717.
[19] 吴毅琴,陈波,朱常青.冠状动脉CT造影结合颈动脉超声与血清学标志物评价2型糖尿病合并冠心病的临床意义[J].中国糖尿病杂志,2016,24(10):908-913
[2] 赵克强,吴巍巍,赵俊来,等.颈动脉狭窄合并糖尿病患者行颈动脉内膜剥脱术的疗效分析[J].中华医学杂志,2015,95(44):3584-3587.
[3] 房振,宋书凯,李敬田.2型糖尿病合并冠心病患者血浆hs-CRP、IL-6与颈动脉内中膜厚度的相关性[J].山东医药,2016,56(14):50-52.
[4] 何雁,李小晶,彭红艳,等.超声造影时间-强度曲线评价颈动脉粥样硬化斑块稳定性与2型糖尿病并发冠心病的相关性[J].实用医学杂志,2016,32(4):600-603.
[5] Bowden D W,Cox A J.Diabetes:Unravelling the enigma of T2DM and cardiovascular disease[J].Nat Rev Endocrinol,2013,9(11):632-633.
[6] 徐向进,潘长玉,田慧,等.WHO及美国糖尿病学会糖尿病诊断标准在老年人群中应用的分析和评估[J]中华内分泌代谢杂志,2002,18(5):27-31.
[7] Kablak-ziembicka A,Przewlocki T,Stepien E,et al.Relationship between carotid intima-media thickness,cytokines,atherosclerosis extent and a two year cardiovascular risk in patients with rteriosclerosis[J].Kardiol Pol J,2011,69(10):1024-1031.
[8] 王巧凤,周晓芳.甘油三酯与心血管剩留风险[J].实用医院临床杂志,2013,10(5):257-259.
[9] 汇波,武越,许文亮,等.颈动脉超声检查评价糖尿病患者冠状动脉粥样硬化的意义[J].临床荟萃,2013.28(12):1402-1404.
[10] 黎艳,李莉,余枫.2型糖尿病患者趾臂指数和踝臂指数与颈动脉粥样硬化性狭窄的相关性[J].广东医学,2013,34(2):253-255.
[11] 高明杰,华扬,贾凌云.2型糖尿病患者颅内、颈部、下肢动脉粥样硬化性病变的超声研究[J].中华医学超声杂志:电子版,2010,7(10):1691-1698.
[12] 刘梅.冠心病患者颈动脉超声检查的特征[J].心血管康复医学杂志,2011,20(4):110 - 112.
[13] 姜涛,宋秀霞,张敏.2型糖尿病颈动脉内膜中膜厚度与胰岛素抵抗的关系[J].中华糖尿病杂志,2005,13(4):260 - 261.
[14] 朱玲,吴琳娜,曾忠仪,等.2型糖尿病合并冠心病患者颈动脉狭窄的筛查价值[J].成都医学院学报,2018,13(2):169-172
[15] 陈绚,李国辉,黄云旗,等.颈动脉超声应用筛查颈动脉狭窄及脑卒中高危因素分析[J].国际神经病学神经外科学杂志,2016,43(4):302-305
[16] 孙秀芹,包柄楠,赵怡,等.行冠状动脉重建术的糖尿病与非糖尿病患者颈动脉病变特点研究[J].中国全科医学,2017,20(13):1597-1600.
[17] 贾晓东,潘晓芳.颈动脉超声在筛查颈动脉狭窄及脑卒中高危人群中的应用[J].中国现代药物应用,2015,9(19):40-41.
[18] 任全刚,崔春燕,刘岳峰.脑梗死患者颈动脉彩超诊断颈动脉粥样硬化的临床价值分析[J].北京医学,2015,37(7):716-717.
[19] 吴毅琴,陈波,朱常青.冠状动脉CT造影结合颈动脉超声与血清学标志物评价2型糖尿病合并冠心病的临床意义[J].中国糖尿病杂志,2016,24(10):908-913