Torremocha F, Hadjadj S, Carrié F, Rosenberg T, Herpin D, Maréchaud R
Clinic of Diabetology, University Hospital, BP 577, 86021 Poitiers Cedex, France.
Diabetes Metab. 2001 Feb;27(1):49-57.
The aim of this study was to examine the predictive value of coronary risk profile (CRP) for major coronary events in patients screened for silent myocardial ischemia (SMI). We studied 72 diabetic patients, aged 41 to 65 years, recruited consecutively at the Poitiers diabetes clinic. All patients had at least one cardiovascular risk factor associated with diabetes mellitus (type 1 diabetes duration > or =15 years, dyslipidaemia, smoking, hypertension, micro/macro-albuminuria). A structured questionnaire, physical examination and resting electrocardiogram provided no evidence of coronary heart disease. SMI was defined as positive exercise electrocardiogram and/or dipyridamole thallium myocardial scintigraphy. CRP was estimated using the Framingham equation adapted to the French population. We defined a high CRP value as annual CRP > or =1.5%. Major coronary events (MCE) were defined as myocardial infarction, ischaemic heart failure, unstable angina or sudden death. Twenty-one patients with type 1, and 51 with type 2 diabetes were followed up for 39+/-12 months: 30 women and 42 men, aged 55+/-7 years with diabetes duration of 16 +/- 11 years (mean +/- SD). SMI was detected in 8 patients. Major coronary events occurred in 8 patients, 2 of whom had SMI. High CRP was found in 18 patients, 3 of whom had MCE. CRP was significantly higher in those patients with a major coronary event (1.71 +/- 1.11 versus 1.03 +/- 0.56%; p=0.048), but not in those with SMI (1.19 +/- 0.72 vs 1.09 +/- 0.67%; p=0.654). In Kaplan-Meier survival analysis, a high CRP was associated with the risk of a major coronary event (log-rank=5.36; p=0.021), whereas SMI was not (log-rank=2.02; p=0.155). The cumulative incidence of MCE in those patients with high and low CRP was 8.08 (0.49-15.67) vs 2.15 (0.06-4.22) events per 100 patient year of follow-up, respectively.
CRP had a good predictive value for major coronary events regardless the presence of SMI. Prevention should therefore be focused primarily on patients with high CRP, wether or not they have SMI.
本研究旨在探讨冠心病风险谱（CRP）对无症状心肌缺血（SMI）筛查患者主要冠状动脉事件的预测价值。我们研究了72例年龄在41至65岁之间的糖尿病患者，这些患者是在普瓦捷糖尿病诊所连续招募的。所有患者至少有一种与糖尿病相关的心血管危险因素（1型糖尿病病程≥15年、血脂异常、吸烟、高血压、微量/大量白蛋白尿）。结构化问卷、体格检查和静息心电图均未发现冠心病证据。SMI定义为运动心电图阳性和/或双嘧达莫铊心肌闪烁显像阳性。CRP采用适用于法国人群的弗雷明汉方程进行估算。我们将高CRP值定义为年度CRP≥1.5%。主要冠状动脉事件（MCE）定义为心肌梗死、缺血性心力衰竭、不稳定型心绞痛或猝死。21例1型糖尿病患者和51例2型糖尿病患者接受了39±12个月的随访：30名女性和42名男性，年龄55±7岁，糖尿病病程16±11年（均值±标准差）。8例患者检测到SMI。8例患者发生了主要冠状动脉事件，其中2例有SMI。18例患者CRP升高，其中3例发生了MCE。发生主要冠状动脉事件的患者CRP显著更高（1.71±1.11对1.03±0.56%；p=0.048），但SMI患者中CRP无显著差异（1.19±0.72对1.09±0.67%；p=0.654）。在Kaplan-Meier生存分析中，高CRP与主要冠状动脉事件风险相关（对数秩检验=5.36；p=0.021），而SMI则无相关性（对数秩检验=2.02；p=0.155）。高CRP组和低CRP组患者MCE的累积发生率分别为每100患者年随访8.08（0.49 - 15.67）例和2.15（0.06 - 4.22）例。
无论是否存在SMI，CRP对主要冠状动脉事件均具有良好的预测价值。因此，预防应主要针对CRP升高的患者，无论他们是否有SMI。
