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1 BACKGROUND Diabetes mellitus with many serious complications with sequelaes sometimes very heavy if not detected early and treated well, which should include marcrovascular disease called atherosclerosis Along with the status artery lesions, a sign appeared very early in patients with type diabetes is microalbuminuria status slight increase in urine albumin excretion during routine tests still result in negative proteinuria Many studies of authors have shown that microalbuminuria is not only an early sign of diabetic kidney disease but also was associated with marcrovascular disease and coronary heart disease With the recent advent of Multi Slice Computed Tomography (MSCT) - including 64 slice Computed Tomography - the study of coronary artery system has become much more simple In Vietnam, to date no research about the level of lesion calcification and coronary atherosclerosis detected by 64-MSCT and between them related with microalbuminuria and the other risk factors in patients with type diabetes Therefore we conducted this study to: Rating characteristic calcifications and atherosclerosis, coronary artery stenosis in patients with type diabetes by 64 slice computed tomography Understanding the relationship between the degree of calcification and atherosclerosis, coronary artery stenosis on 64 slice computed tomography with microalbuminuria and some risk factors for coronary artery disease in patients with type diabetes CHAPTER OVERVIEW 1.1.CORONARY ARTERY DISEASE IN PATIENTS WITH TYPE DIABETES 1.1.1 Epidemiology * Epidemiology of coronary heart disease (CHD) Currently worldwide there are about 40 million people with CHD Each year, about over 5.8 million people with CHD CHD is the leading cause of mortality in cardiovascular disease In 2001 there were 7.2 million people died of CHD In Vietnam CHD is increasing dramatically According to the statistics from before 1963, the CHD is very rare but then CHD began to rise Particularly in Ho Chi Minh City in 2000 there were 3222 patients with myocardial infarction and 122 fatal cases in that * Coronary heart disease in patients with type diabetes Through a lot of research in many different centers was found that the risk of CHD in patients with type diabetes increased 2-4 times compared to people without diabetes While the rate of CHD in the general population is 2-4%, this rate in diabetic patients increased significantly to 55% Mortality due to cardiovascular in people type diabetes diseases and high up to 2-6 times more than people without diabetes 1.1.2 The pathogenesis of atherosclerosis in patients with type diabetes * important disorders in diabetes: + Dysfunction of endothelial cells + Dysfunction vascular smooth muscle cells + Platelet dysfunction + Coagulation abnormalities in diabetes * The deposition of calcium in the coronary arteries: The calcification in arteries began forming early in the second decade of the life, even more soon Calcium phosphate (Hydroxyapatite, Ca3[-PO4]2-xCa[OH]2) is the main apatite are found in the same plaques compounds in bone formation and repair Electronic Microscope determine the calcium crystal deposition starting from a small amount of the artery cells, similar to cartilage Besides, the died foam cells with the lipid core also contribute positively in the deposition of calcium 1.1.3 Coronary atherosclerotic detection by 64-MSCT + Coronary Artery Calcium Score - CACS: Agatston score was introduced in 1990, is a traditional method to quantify calcium by computed tomography electron beam This method is based on the platform of the largest weakening of X-ray or CTnumber (measured in HU) and the deposition of calcium + Plaque characteristics: Plaque is evaluated through the identification of structural density Soft plaque ( noncalcification plaque) lower proportion with intravascular contrast agents Hard plaque or calcified plaque when proportion ≥ 120 HU, even up to > 1000 HU Mixed plaque is the plaque including calcification and noncalcification Photo 1.2 A noncalcification plaque MPR Photo1.3 A mixed plaque MPR (arrow) A plaque is called straight shaft (or concentric) when plaque axis running along the long axis of the vessels on one side of it, but must not exceed 25% of the lumen diameter Call the misalignment (eccentricity) when the shaft deflect with the axis lumen Assess coronary artery stenosis on the following factors: location, length of stenosis,% lumen stenosis There are many ways a narrow circuit split but divided into ways depending on the diameter of the narrowed lumen, from the (no stenosis) to level IV (complete obstruction) is the most widely used The evaluation of stenosis sometimes encounter difficulties especially when high levels of calcium (> 1000 points) Photo 1.5 Serve stenosis in middle LCx with the noncalcification plaque A: 3D image; B: MIP image; C: Curved MPR image; D: Hình ảnh QCA When lumen stenosis 0,05 > 0,05 - The percentage of patients with risk factors for coronary artery disease in the study is high, particularly the rate of hypertension and overweight / obesity - Men have a higher proportion than women on the risk factors: overweight / obesity, abdominal obesity, dyslipidemia and hypertension (p