内科

目的探讨老年2型糖尿病（T2DM）患者颈动脉内-中膜厚度（IMT）与冠心病（CAD）之间的关系。方法随机选取133例T2DM患者，根据冠状动脉造影检查结果分为CAD组（伴CAD，35例）和非CAD组（不伴CAD者，98例），检测两组患者的IMT及颈动脉斑块情况，绘制ROC曲线，评估其诊断T2DM伴CAD的价值。结果CAD组患者的IMT较非CAD组明显增厚，斑块分级显著高于非CAD组（P＜0.05）；Logistic多因素回归分析显示ICA-IMT、CCA-IMT及斑块分级是T2DM伴CAD的独立危险因素（P＜0.05）；通过ROC曲线分析显示，以颈内动脉起始处-内中膜厚度（ICA-IMT）≥0.9 mm、双侧颈总动脉-内中膜厚度（CCA-IMT）≥1.3 mm以及斑块分级≥2中任意2项作为阳性，诊断CAD的特异度为84.25%，灵敏度为95.33%。结论ICA-IMT、CCA-IMT及颈动脉斑块分级是T2DM合并CAD的独立危险因素，检测IMT及对颈动脉斑块进行分级可作为预测T2DM合并CAD安全、有效、无创性指标。

ObjectiveTo investigate the relationship between carotid intima-media thickness (IMT) and coronary artery disease in elderly patients with type 2 diabetic. MethodsA total of 133 elderly patients with type 2 diabetic were divided into CAD group (n=35) and non-CAD group (n=98) according to the results of coronary angiography, IMT and carotid artery plaques plotted of the two groups were measured, the diagnostic value of IMT and carotid artery plaques plotted for patients with type 2 diabetic combined coronary artery disease were evaluated by ROC curve. ResultsThe IMT in CAD group was significantly thicker than that in non-CAD group, and the grade of carotid artery plaques plotted in CAD group was significantly higher than that in non-CAD group (P＜0.05); the Logistic regression analysis show that ICA IMT, CCA IMT and grade of carotid artery plaques plotted were the independent risk factors of type 2 diabetic combined coronary artery disease(P＜0.05); ROC curve analysis showed that any two indexes (ICA IMT≥0.9mm，CCA IMT≥1.3mm, grade of carotid artery plaques plotted≥2) as positive to diagnose CAD, the specific degrees was 84.25% and the sensitivity was 95.33%. ConclusionsICA IMT, CCA IMT and grade of carotid artery plaque are the independent risk factors of T2DM combined CAD, to predict T2DM combined CAD by detecting IMT and grading carotid artery plaques plotted is safety, effective and noninvasive.