冠狀動脈心臟電腦斷層鈣化斑塊指數與抽菸及糖尿病之關連性研究

The Correlation among CAC Score, Smoking History and Diabetes

翁靜如(Jing-Ru Weng)

指導教授 ： 陳清江

共同指導教授 ： 陳泰賓(Tai-Been Chen)

義守大學/電機資訊學院/資訊工程學系/碩士(2015年)

https://doi.org/10.6343/ISU.2015.00127

摘要

本研究主要目的為評估抽菸和糖尿病與冠狀動脈鈣化之斑塊特徵的關係。採用回溯性研究，收集自2007年至2014年共695位無症狀體檢者；排除鈣化0分、心臟裝支架以及嚴重影像模糊之案例。當鈣化基準點大於130 HU且鈣化像素至少3點以上；進行鈣化斑塊特徵值估算；再者記錄受案者年齡、性別、抽菸史、糖尿病史等個人參數。年齡以65歲和50歲為分組依據；比較抽菸和糖尿病族群影像特徵之差異及關連性。
分析結果發現小於65歲，有糖尿病者在鈣化數量、鈣化像素個數、平均亞加史東、平均鈣化體積及平均鈣化質量會高於無糖尿病(P=0.001, P=0.011, P=0.012, P=0.007, P=0.007)；性別方面，男性在鈣化數量會多於女性(P=0.002)；等於大於65歲族群，有糖尿病者在鈣化數量會多於無糖尿病者(P=0.013)；結論發現台灣的無症狀者之冠狀動脈鈣化，其不分年齡、糖尿病和抽菸會影響鈣化數量。
本研究發現糖尿病比抽菸對於冠心病更具影響性，但仍不容忽視抽菸對於冠心病引起的風險，不只文獻研究指出抽菸所造成的死亡原因中，死亡人數為冠心病大於肺癌，而根據衛福部統計也發現同樣的結果，因此遠離菸害也是目前主導的方向。

關鍵字

心臟電腦斷層 ； 冠狀動脈鈣化斑塊 ； 糖尿病

並列摘要

The main purpose in this study was to evaluate the relationship among smoking, diabetes, and plaque index of coronary artory calcification (CAC). The retrospective experiment was adopted in this study. Total effective samples were 695 that collected from 2007 to 2014 excluding those of absence of CAC or with stent and images with severe motion artifacts. The calcification index was based on over 130 HU and at least three pixels of calcification. Meanwhile, the subject’s age, gender, history of smoking and diabetes were recorded in data table. The groups of subject were based on 50 or 65 years old. The difference and relationship for CAC imaging features among groups of smoking and diabetes were investigation in this work.
The number of calcified plaque, pixel number of calcified plaque, average of Agatson score, average of calcification volume and average of calcification mass were shown significantly difference between diabetes and non-diabetes groups under age <65 years old (yr) (P=0.001, 0.011, 0.012, 0.007, 0.007). The number of calcified plaque of male group was significantly different with female group (P=0.002). The number of calcified plaque between diabetes and non-diabetes groups was significantly different as age > 65 yr (P=0.013). The group of presence of CAC, the number of calcified plaque was affected by diabetes and smoking history.
The more important effective factor for coronary artory disease (CAD) was the group with presence of diabete than thos of group of smoking. However, the history of smoking was still an important risk factor for CAD acoording to the reports of literature and Ministry of Health and Welfare in Taiwan. Therefore, one of the main issues for decresesing the preveleance of CAD is keeping smoking away.

並列關鍵字

Cardiac Computed Tomography ； Coronary Artery Calcification ； Diabete

參考文獻

1. Oudkerk et al., Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging. Eur Radiol. 2008; 18(12):2785-2807.

2. Nasir et al., Interplay of Coronary Artery Calcification and Traditional Risk Factors for the Prediction of All-Cause Mortality in Asymptomatic Individuals. Circ Cardiovasc Imaging. 2012; 5(4):467-473.

3. Stephen et al., A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lance. 2012; 380(9859):2224-60.

4. Scognamiglio et al., Detection of Coronary Artery Disease in Asymptomatic Patients With Type 2 Diabetes Mellitus. J Am Coll Cardiol. 2006; 47(1):65-71.

5. Krul et al., Coronary artery disease in patients with atypical chest pain with and without diabetes mellitus assessed with coronary CT angiography. BMJ Open Diabetes Res Care. 2014; 2(1):e000004.