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Abstract

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Original Research

JOURNAL：ACC Article Link

冠状动脉钙化评分对I糖尿病患者罹患ASCVD或CAD的危险预测价值

Afiachukwu Onuegbu等撰，CBSMD整理提炼

Pre-reading


1979年发表的“Coronary calcification in the diagnosis of coronary artery disease”阐明了冠脉钙化与T1DM患者后续CVD发生事件的相关性，提示冠脉钙化代表动脉粥样硬化的存在。冠状动脉钙化扫描（coronary artery calcium scan， CAC scan）可在非侵入模式下发现亚临床CAD。标准化钙化评分： 0分表示无钙化斑块、1-10分表示少许钙化， 11-100分为轻度钙化，101-300分为中度钙化，300分以上为重度钙化。"Association of Coronary Artery Calcification With Subsequent Incidence of Cardiovascular Disease in Type 1 Diabetics" 详细地归纳总结了现今有关糖尿病患者CAC评分的研究进展：


1. 从CAC评分对1型糖尿病（T1DM）和2型糖尿病（T2DM）患者未来罹患ASCVD或CAD的预测价值着手， 肯定了冠脉钙化评分相对于其他传统风险因子在CAD疾病进程中的预测价值；

2. 指出10年ASCVD事件发生率与年龄、性别和种族无关，而随CAC评分的增加而增加；
3. 介绍了自2013年起糖尿病已不再被作为CAD的等危症，CAC评分为0的糖尿病患者或可被评估为CAD患病风险低，且短期死亡风险也处于低水平，提示对糖尿病患者开具诊疗策略前应明确危险分层。CAC可作为40岁以上的T2DM患者有效开展CAD患病的非侵入筛查手段;
4. 说明T1DM和T2DM虽在病理生理学上显著不同，但心血管代谢风险存在共性，尽管动脉粥样硬化上的表现不尽相同；CAC评分400+或是最佳判断T1DM心血管风险的阈值；
5. 阐述了他汀作为T2DM患者预防心血管药物的研究成果并不适用于T1DM患者；在参考现存指南给予T1DM患者他汀药物预防的同时应关注CAC评分结果；而CAC评分的缺陷在于不能应用于非钙化软斑块。

6. 总结CAC可辅助临床明确哪类患者可受益于未来五年的一级预防策略。


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