| 1 Background and ObjectivesCoronary heart disease is one of the serious complication in patients with type 2 diabetes diabetes, and it is also one of the main cause of death. Coronary angiography in the diagnosis of coronary artery disease is the "gold standard", but it not only has the disadvantages of high risk, high cost, high technical requirements and equipment conditions, but also is not easy to popularize. The carotid artery is superficial, fixed, easy to be exposed, and study has shown that the carotid artery can be observed as systemic atherosclerosis window. Carotid artery ultrasound is simple, inexpensive, non-invasive and reproducible. So whether the results of carotid artery ultrasound can be used as an important reference in predicting coronary artery disease in patients with type 2 diabetes?This study aims to investigate the correlation between coronary angiography and carotid artery ultrasound in patients with type 2 diabetes diabetes complicated with coronary artery disease and provide some reference value for the prediction and evaluation of carotid artery ultrasound in coronary heart disease by analyzing the general clinical data, blood biochemical index, coronary lesion vessels, severity of lesions and Gensini score and carotid artery vascular CA integral, Crouse product and carotid artery plaque number in patients with type 2 diabetes diabetes no coronary heart disease group, coronary heart disease no type 2 diabetes diabetes group and type 2 diabetes diabetes complicated with coronary heart disease group. 2 MethodsThe selected objects in this study are 164 patients with Coronary angiography, neck vascular ultrasound from the Department of Cardiology were selected in the Second Affiliated Hospital of Zhengzhou University from January 2013 to September 2015. All these patients are divided into the following three groups according to whether they have type 2 diabetes and coronary heart disease: T2 DM group(n=24, type 2 diabetes diabetes without coronary heart disease, including 9 male patients and 15 female patients, with mean age 57.29±9.45), T2DM-CHD group(n=60, type 2 diabetes with coronary heart disease(CHD), including 30 male patients and 30 female patients, with mean age 62.75±9.29), CHD group(n=80, coronary heart disease without type 2 diabetes diabetes, including 65 male patients and 15 female patients, with mean age 61.29±10.31). Meanwhile all the 140 patients from T2DM-CHD group and CHD group are divided into the following three groups according to the number of diseased coronary artery: single-vessel-lesion group, double-vessel-lesion group and three-branch-lesion group. And furthermore according to the coronary Gensini score, all the 164 patients are divided into mild group(<20), moderate group(20-40) and severe group(>40).The study collected all selected clinical data of the patients: recording the gender, age, smoking history and the history of hypertension; Recording glycosylated hemoglobin(Hb A1C)(%), trigiyceride(TG), cholesterol(TC), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C); Recording the results of coronary angiography, including the diseased number of the coronary artery, the diseased vessel name, the degree of stenosis and diffuse lesions; Recording carotid artery ultrasound results, including the degree of stenosis of carotid atherosclerosis(%), patch number and thickness(mm). The study contained the methods as below: Calculating the Gensini score of coronary artery, and analyzing the degree of coronary artery stenosis; Calculating the Crouse score and CA score of carotid artery, and analyzing the degree of carotid artery atherosclerosis; Analyzing general clinical data, blood biochemical indexes, results of coronary lesions and carotid atherosclerosis in the T2 DM group, T2DM-CHD group and CHD group. 3 Results 3.1 General clinical data comparisonThe age gradually increased in the T2 DM group, the CHD group and the T2DM-CHD group, and the difference was not significant in these three groups(P>0.05). By comparing the T2DM-CHD group with the T2 DM group, the percent of male patients, the prevalence rate of hypertension patients and the number of smoker were higher in the T2DM-CHD group, and the composition of gender and the number of smoker were not significant difference in these two groups(P>0.05), but the prevalence rate of hypertension was obviously different(P<0.05). By comparing the T2DM-CHD group with the CHD group, the percent of female patients, the prevalence rate of hypertension patients were higher in the T2DM-CHD group, the number of smoker was lower in the T2DM-CHD group, and they were significant difference in these two groups(P<0.05). 3.2 Comparison of blood biochemical indexesTC gradually decreased in the T2 DM group, the T2DM-CHD group and the CHD group, but there was not significant difference in these three groups(P>0.05). By comparing the T2DM-CHD group with the T2 DM group, TG was higher in the T2DM-CHD group, but the difference was not significant in these two groups(P>0.05); The level of HDL and LDL were lower in the T2DM-CHD group, and the difference was statistical(P<0.05); In addition, the level of Hb A1 C was significantly higher in the T2DM-CHD group, and the difference was statistical in these two groups(P<0.05). By comparing the T2DM-CHD group with the CHD group, the level of HDL in the T2DM-CHD group was higher, but there was not statistically different(P>0.05); The level of TG and Hb A1 C was significantly higher in the T2DM-CHD group, and the difference was not significant(P<0.05); In addition, the level of LDL in the T2DM-CHD group was obviously lower, and the difference was statistical(P<0.05). 3.3 Comparison of coronary angiography with T2DM-CHD group and CHD groupThe ratio of triple vessel disease and the ratio of diffuse lesions in the T2DM-CHD group were significantly higher than those in the CHD group, and the difference was statistical(P<0.05); The ratio of single vessel disease and the ratio of the double vessel disease in the CHD group were statistically higher than those in the T2DM-CHD group, and the difference was statistical(P<0.05); The ratio of right coronary artery(RCA) disease in the T2DM-CHD group was obviously higher than that in the CHD group, and the difference was statistical(P<0.05); The ratio of left anterior descending(LAD) disease in the T2DM-CHD group was lower than that in the CHD group, and the difference was statistical(P<0.05); The ratio of left main stem(LM) disease and the ratio of left circumflex(LCX) disease were not statistically different in these two groups(P>0.05). 3.4 Comparison of the Gensini scoreThe Gensini score in the T2DM-CHD group was much higher than that in the T2 DM group, and tthe difference was statistical in these two groups(P<0.001); The Gensini score in the T2DM-CHD group was higher than that in the CHD group, but the difference was not statistical in these two groups(P>0.05). 3.5 Comparison of cervical vascular ultrasoundBy comparing the T2DM-CHD group with the T2 DM group, the Crouse integral, CA integral, the number of patch in the T2DM-CHD group were much higher than those in the T2 DM group, and the difference was statistical in the two groups(P<0.01); The Crouse integral, CA integral, the number of patch in the T2DM-CHD group were much higher than those in the CHD group, but the difference not different in the two groups(P>0.05); Carotid Crouse score, CA score and the number of plaque increased with the Gensini score of coronary artery increasing, and the difference was significant in the mild group and moderate group(P<0.05), the difference was significant different mild group and severe group(P<0.05), but the difference was not significant in the moderate group and the severe group(P>0.05). 3.6 Comparison of carotid artery ultrasound and coronary artery lesion between T2DM-CHD group and CHD groupThe Crouse score of the carotid artery in the double-vessel-disease group was higher than those in the single-vessel-disease group and the triple-vessel-disease group, and the difference was significant in the double-vessel-disease group and the single-vessel-disease group(P<0.05); With the number of diseased coronary artery increasing, the carotid artery CA integral and the number of patches also increased, and the difference was obvious in the single-vessel-disease group and the triple-vessel-disease group(P<0.05); The Crouse score, CA score and the number of patches of carotid artery in the diffuse-disease group were higher than those in the non-diffuse-lesion group, and they were only significantly different in the CA score(P<0.05). 3.7 Correlation analysisThere were positive correlations between Coronary Gensini score and neck vascular ultrasound Crouse score, CA score, plaque number(γ=0.230、0.356、0.243). 4 Conclusion4.1 In the patients with type 2 diabetes, carotid artery ultrasound can be used as an important examination in predicting the occurrence and assessing the severity of coronary artery disease; 4.2 In the patients with type 2 diabetes with coronary heart disease, coronary artery disease is more complex, multiple, diffuse and severe stenosis, and higher incidence in RCA involvement rate. |
