摘要
目的探讨2型糖尿病患者胰腺脂肪浸润与冠状动脉粥样硬化的关系。方法连续性纳入2016年1月至2019年2月因胸痛于首都医科大学附属北京世纪坛医院行冠状动脉CT血管成像(CCTA)检查的2型糖尿病患者。根据CCTA结果将患者分为冠状动脉正常组、轻中度狭窄组及重度狭窄组。在腹部CT平扫图像上测量胰腺及脾脏的CT值,并计算CT密度指数[胰腺与脾脏的密度差值(P-S)和胰腺与脾脏密度比值(P/S)]。应用方差分析、Kruskal-Wallis秩和检验比较各组患者的差异。应用Logistic回归分析冠状动脉重度狭窄的相关因素。应用受试者工作特征曲线分析P/S预测冠状动脉重度狭窄的准确性。结果共纳入173例2型糖尿病患者,其中冠状动脉正常组27例(15.6%)、轻中度狭窄组124例(71.7%)、重度狭窄组22例(12.7%)。3组胰腺CT值(Z=11.543,P=0.003)、P-S(Z=11.152,P=0.004)及P/S(Z=11.327,P=0.004)差异均有统计学意义。冠状动脉狭窄患者胰头、胰体及胰尾CT值差异有统计学意义(Z=14.737,P=0.001)。校正混杂因素后,多因素Logistic回归显示P/S(OR=0.062,95%CI=0.008~0.487,P=0.008)与冠状动脉重度狭窄仍具有相关性。P/S预测冠状动脉重度狭窄的受试者工作特征曲线下面积为0.701,最佳截断点为0.660。结论2型糖尿病患者胰腺CT值、CT密度指数与冠状动脉狭窄程度有相关性,提示胰腺脂肪浸润可作为冠状动脉重度狭窄的预测因子之一。
Objective To investigate the association of pancreatic steatosis with coronary atherosclerosis in patients with type 2 diabetes mellitus(T2DM).Methods Patients with T2DM who underwent coronary computed tomography angiography(CCTA)in our center due to chest pain were enrolled from January 2016 to February 2019.According to the CCTA findings,patients were divided into normal group,mild-to-moderate coronary atherosclerosis group and severe coronary atherosclerosis group.CT attenuation of pancreas and spleen was measured on abdominal non-enhanced CT,and the CT attenuation indexes including the difference between pancreatic and splenic attenuation(P-S)and the ratio of pancreas-to-spleen attenuation(P/S)were calculated.Analysis of variance or Kruskal-Wallis rank test were used to assess differences among each group.Logistic regression analysis was used to analyze the risk factors of severe coronary stenosis.The accuracy of P/S in predicting severe coronary artery stenosis was assessed by receiver operator characteristic(ROC)curve analysis.Results A total of 173 consecutive T2DM patients were enrolled.These patients included 27 patients with normal coronary artery(15.6%),124 patients with mild to moderate stenosis(71.7%),and 22 patients with severe stenosis(12.7%).There were significant differences in CT attenuation of pancreas(Z=11.543,P=0.003),P-S(Z=11.152,P=0.004)and P/S(Z=11.327,P=0.004)among normal coronary artery group,mild and moderate stenosis group,and severe stenosis group.The CT attenuation of pancreatic head,body,and tail significantly differed in patients with coronary artery stenosis(Z=14.737,P=0.001).After adjusting for confounding factors,multiple Logistic regression showed that P/S(OR=0.062,95%CI=0.008-0.487,P=0.008)was still significantly associated with the severe coronary artery stenosis.The area under the ROC curve of P/S for the diagnosis of severe coronary artery stenosis was 0.701,and the optimal cutoff point was 0.660.Conclusion CT attenuation of pancreas and CT attenuation indexes are associated with the severity of coronary stenosis in T2DM patients,suggesting that pancreatic steatosis may be used as one of the indicators for predicting severe coronary artery stenosis.
作者
孙朋涛
都雪朝
王若顿
孙莹
孙小丽
赵桐
魏海亮
王仁贵
SUN Pengtao;DU Xuechao;WANG Ruodun;SUN Ying;SUN Xiaoli;ZHAO Tong;WEI Hailiang;WANG Rengui(Department of Radiology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Radiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China;Medical Department,Xiamen Humanity Hospital,Xiamen,Fujian 361006,China)
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2020年第2期172-177,共6页
Acta Academiae Medicinae Sinicae
关键词
胰腺脂肪
计算机断层扫描
糖尿病
冠心病
pancreatic fat
computed tomography
diabetes mellitus
coronary artery disease
