本文選題：冠狀動脈造影 + 粥樣硬化斑塊��； 參考：《華北理工大學》2017年碩士論文

【摘要】：目的1探討血糖對冠狀動脈粥樣硬化患者冠狀動脈斑塊數目、性質及狹窄程度的影響。2探討Hb A1c對糖尿病患者冠狀動脈斑塊性質及狹窄程度的影響。方法1選取2016年3月至6月于華北理工大學附屬醫(yī)院接受256層CT冠狀動脈檢查的冠狀動脈粥樣硬化患者171例,根據血糖水平分為三組,Ⅰ組(無血糖異常,n=82)、Ⅱ組(葡萄糖調節(jié)受損IGR,n=30)、Ⅲ組(2型糖尿病T2DM,n=59)。記錄每位患者的一般資料(性別、年齡、體重指數、高膽固醇血癥、高血壓及吸煙史),分別統(tǒng)計每條血管的鈣化斑塊、非鈣化斑塊及混合斑塊的數目,并統(tǒng)計每條血管的狹窄程度。分別比較三組患者粥樣硬化斑塊的數目、不同性質斑塊及冠狀動脈不同狹窄程度的檢出情況。2選取2016年5月至9月于華北理工大學附屬醫(yī)院接受256層CT冠狀動脈檢查的糖尿病患者108例,根據Hb A1c水平分為兩組,Ⅰ組(伴二型糖尿病(T2DM),Hb A1c8.0%,(血糖控制一般)n=56),Ⅱ組(伴T2DM,Hb A1c≥8.0%,(血糖控制不好)n=52)。記錄每位患者的一般資料(性別、年齡、體重指數、總膽固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、高血壓及吸煙史),分別統(tǒng)計每條血管的鈣化斑塊、非鈣化斑塊及混合斑塊的數目,并統(tǒng)計每條血管的狹窄程度。分別比較兩組患者不同性質斑塊及冠狀動脈不同狹窄程度的檢出情況結果1無血糖異常組、伴IGR組、伴T2DM組,發(fā)現粥樣硬化斑塊的數目分別為201個、123個及252個,平均斑塊數分別為2.48±0.94個、4.10±2.02個及4.27±1.85個,三組相比,差異有統(tǒng)計學意義(F=27.357,P=0.000,P0.05)。IGR組與T2DM組平均斑塊數相比,差異無統(tǒng)計學意義(P=0.619,P0.05)。無血糖異常組鈣化斑塊、非鈣化斑塊及混合斑塊的檢出率分別為60.7%、15.4%及23.9%,伴IGR組鈣化斑塊、非鈣化斑塊及混合斑塊的檢出率分別為44.7%、22.0%及33.3%,伴T2DM組鈣化斑塊、非鈣化斑塊及混合斑塊的檢出率分別為34.5%、28.6%及36.9%,三組相比,差異有統(tǒng)計學意義(χ2=31.498,P=0.000,P0.05)。無血糖異常組與IGR組,無血糖異常組與T2DM組,各類斑塊的檢出率相比,差異具有統(tǒng)計學意義(χ2=7.886,P=0.020;χ2=31.197,P=0.00)。IGR組與T2DM組,各類斑塊檢出率相比,差異無統(tǒng)計學意義(χ2=3.935,P=0.140)。無血糖異常組輕度狹窄、中度狹窄及重度狹窄的檢出率分別為66.5%、21.3%及12.2%,伴IGR組輕度狹窄、中度狹窄及重度狹窄的檢出率分別為23.0%、35.1%及41.9%,伴T2DM組輕度狹窄、中度狹窄及重度狹窄的檢出率分別為21.0%、35.6%及43.4%。三組相比,差異有統(tǒng)計學意義(χ2=83.421,P=0.000,P0.05)。無血糖異常組與IGR組、無血糖異常組與T2DM組冠狀動脈狹窄程度檢出率差異有統(tǒng)計學意義(Z=㧟6.462,P=0.000,P0.05;Z=㧟8.719,P=0.000,P0.05)。IGR組與T2DM組冠狀動脈狹窄程度檢出率差異無統(tǒng)計學意義(Z=㧟0.320,P=0.749,P0.05)。2伴T2DM血糖控制一般組鈣化斑塊、非鈣化斑塊及混合斑塊的發(fā)生率分別為56.7%、20.1%及23.2%,伴T2DM血糖控制不好組鈣化斑塊、非鈣化斑塊及混合斑塊的發(fā)生率分別為30.9%、31.3%及37.8%,兩組相比,差異有統(tǒng)計學意義(χ2=27.886,P=0.000,P0.05)。伴T2DM血糖控制一般組輕度狹窄、中度狹窄及重度狹窄的檢出率分別為52.8%、30.8%及16.4%,伴T2DM血糖控制不好組輕度狹窄、中度狹窄及重度狹窄的檢出率分別為24.7%、40.4%及34.9%,兩組相比,差異有統(tǒng)計學意義(Z=㧟5.365,P=0.001,P0.05)。結論1與血糖正常者相比,血糖異常者冠狀動脈粥樣硬化斑塊數目增多,混合斑塊及非鈣化斑塊的檢出率升高,鈣化斑塊的檢出率降低,冠狀動脈狹窄程度加重。2糖代謝異常者與糖尿病患者相比,其冠狀動脈病變程度相似。3糖尿病患者,隨著Hb A1c水平的升高,冠狀動脈混合斑塊及非鈣化斑塊的檢出率升高,鈣化斑塊的檢出率降低,冠狀動脈狹窄程度加重。
[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.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4;R816.2

【參考文獻】

相關期刊論文 前10條

1 曲歌樂;錢玉英;周英智;朱紅;;2型糖尿病患者血清同型半胱氨酸與凝血指標致動脈粥樣硬化的作用[J];山西醫(yī)科大學學報;2017年01期

2 陳建平;;CT冠狀動脈成像與冠狀動脈造影診斷冠心病的臨床價值對照分析[J];中國CT和MRI雜志;2017年01期

3 徐家庚;;糖化血紅蛋白在糖尿病患者診療中的臨床意義探討[J];基層醫(yī)學論壇;2016年35期

4 葉青;余華;葉山東;許英;;冠心病患者糖化血紅蛋白與冠脈病變嚴重程度的相關性[J];中國臨床保健雜志;2016年06期

5 夏蘭蘭;曹偉;;用MSCT評估冠狀動脈粥樣硬化斑塊穩(wěn)定性的臨床價值[J];中國處方藥;2016年11期

6 張維龍;;糖化血紅蛋白檢測對糖尿病微血管病變評估的價值[J];中國繼續(xù)醫(yī)學教育;2016年25期

7 方釗;蔣學俊;陶波;劉浙波;王建銘;;老年單純冠心病合并糖尿病患者冠狀動脈病變嚴重程度及特點分析[J];醫(yī)學研究雜志;2016年08期

8 鄭堅銳;鄭振達;稅星;劉定輝;溫哲琦;陳t，

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