The association of hemoglobin Alc and high risk plaque and plaque extent assessed by coronary computed tomography anglography.
The association of hemoglobin Alc and high risk plaque and plaque extent assessed by coronary computed tomography anglography.
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通过冠状动脉计算机断层扫描血管造影评估血红蛋白 Alc 与高风险斑块和斑块范围的关联。
DOI：
10.1007/s10554-015-0788-6
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Nakamura S.
中科院分区：
文献类型：
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作者：
Tomizawa N;Inoh S;Nojo T;Nakamura S.
本研究的目的是探讨血红蛋白A1 c（HbA 1c）与斑块特征（包括高危斑块和斑块范围）的关系。我们回顾性研究了1079例连续冠状动脉计算机断层扫描（CT）血管造影扫描和HbA 1c结果。我们根据HbA 1c状态将患者分为四组：非糖尿病，≤6.0;临界，6.1-6.4;糖尿病低，6.5-7.1;糖尿病高，>7.1。我们确定节段受累评分>4为广泛性疾病。高危斑块定义为两个特征阳性（FP）斑块，即正重塑（重塑指数>1.1）和低衰减（<30 HU）斑块。进行单因素和多因素分析，包括传统的心血管危险因素，症状和药物治疗。单因素分析显示糖尿病患者和临界糖尿病患者与2FP斑块和广泛性疾病显著相关。虽然在多变量分析中临界患者与2FP斑块的关系是边缘性的[比值比（OR）1.53，95%可信区间（CI）0.95- 2.40，p = 0.07]，但HbA 1c升高与2FP斑块密切相关（糖尿病低OR 2.19，95%CI 1.37- 3.45，p < 0.005;糖尿病高OR 4.14，95%CI 2.57- 6.67，p < 0.0005）。HbA 1c升高与广泛性疾病的关系在临界糖尿病患者和糖尿病患者之间非常相似（临界值OR 1.96，95%CI 1.29- 2.95，p < 0.005;糖尿病低值OR 1.94，95%CI 1.25- 3.01，p < 0.005;糖尿病高值OR 2.19，95%CI 1.39- 3.43，p < 0.005）。HbA 1c升高>6.0的患者由于增加的高风险斑块和广泛的疾病，甚至低于6.5的糖尿病水平，可能存在未来心血管事件的风险。冠状动脉CT可用于这些患者的危险分层。
The objective of this study was to investigate the relationship of Hemoglobin A1c (HbA1c) and plaque characteristics including high risk plaque and plaque extent. We retrospectively examined 1079 consecutive coronary computed tomography (CT) angiography scans and the HbA1c results. We divided the patients into four groups by the HbA1c status: non-diabetic, ≤6.0; borderline, 6.1–6.4; diabetic low, 6.5–7.1; diabetic high, >7.1. We determined segment involvement score >4 as extensive disease. High risk plaque was defined as two feature positive (FP) plaque which consists of positive remodeling (remodeling index >1.1) and low attenuation (<30 HU). Univariate and multivariate analysis including conventional cardiovascular risk factors, symptoms and medication was performed. Univariate analysis showed that diabetic patients as well as borderline patients were significantly related with 2FP plaque and extensive disease. Although the relationship of borderline patients and 2FP plaque was marginal in multivariate analysis [odds ratio (OR) 1.53, 95 % confidence interval (CI) 0.95–2.40,p= 0.07], the elevation of HbA1c was strongly associated with 2FP plaque (diabetic low, OR 2.19, 95 % CI 1.37–3.45,p< 0.005; diabetic high, OR 4.14, 95 % CI 2.57–6.67,p< 0.0005). The association of HbA1c elevation and extensive disease was quite similar between borderline and diabetic patients (borderline, OR 1.96, 95 % CI 1.29–2.95,p< 0.005; diabetic low, OR 1.94, 95 % CI 1.25–3.01,p< 0.005; diabetic high, OR 2.19, 95 % CI 1.39–3.43,p< 0.005). Patients with elevated HbA1c of >6.0 are potentially at risk for future cardiovascular events due to increased high risk plaque and extensive disease, even below the diabetic level of 6.5. Coronary CT could be used for risk stratification of these patients.