Khaleeli E, Peters S R, Bobrowsky K, Oudiz R J, Ko J Y, Budoff M J
Division of Cardiology, St John's Cardiovascular Research Center, Harbor-University of California, Los Angeles, Medical Center Research and Education Institute, Torrance, CA 90502, USA.
Am Heart J. 2001 Apr;141(4):637-44. doi: 10.1067/mhj.2001.113224.
We sought to examine the prevalence, sensitivity, and specificity of coronary calcium (CC), a marker of atherosclerosis, in a population of symptomatic and asymptomatic diabetic persons.
We used electron beam tomography (EBT) to quantitate CC in 168 symptomatic (chest pain or anginal equivalent) persons with diabetes who underwent coronary angiography and then compared this with a cohort of 155 asymptomatic persons with diabetes.
In the 168 symptomatic diabetic persons, 124 (74%) had obstructive coronary artery disease (CAD) by angiography. Receiver-operator characteristic curve analysis was used to maximize sensitivity and specificity for obstructive CAD (>50% stenosis), which established a CC score of 102 as optimal. With use of this cut point, EBT has a sensitivity of 77% and a specificity of 77% for detecting obstructive CAD. Of the 155 asymptomatic diabetic persons, 72% had CC and 48% had a CC score >102. The presumed prevalence of obstructive disease (on the basis of EBT scores and prevalence of CC) among asymptomatic diabetic persons is quite high (as high as symptomatic persons without diabetes). Analyzing the 323 diabetic patients demonstrated no significant age difference in CC scores between women and men.
This study confirms that higher CC scores should be used in diabetic patients to improve the specificity of CC to determine obstructive disease. EBT can allow a noninvasive diagnosis of CAD before clinical presentation, allowing for more therapy for those in which CC is detected. These results suggest that asymptomatic diabetic persons have the same atherogenic burden of those patients with CAD without diabetes. The high prevalence of CC in asymptomatic persons with diabetes supports the need for aggressive management of diabetes and associated risk factors.
我们试图在有症状和无症状的糖尿病患者群体中，研究动脉粥样硬化标志物冠状动脉钙化（CC）的患病率、敏感性和特异性。
我们使用电子束断层扫描（EBT）对168例有症状（胸痛或等效心绞痛）的糖尿病患者进行冠状动脉造影时的CC进行定量，然后将其与155例无症状糖尿病患者队列进行比较。
在168例有症状的糖尿病患者中，124例（74%）经血管造影显示有阻塞性冠状动脉疾病（CAD）。采用受试者操作特征曲线分析来最大化阻塞性CAD（狭窄>50%）的敏感性和特异性，确定CC评分为102时为最佳。使用该切点，EBT检测阻塞性CAD的敏感性为77%，特异性为77%。在155例无症状糖尿病患者中，72%有CC，48%的CC评分>102。无症状糖尿病患者中阻塞性疾病的推测患病率（基于EBT评分和CC患病率）相当高（与无糖尿病的有症状患者一样高）。分析323例糖尿病患者发现，女性和男性的CC评分在年龄上无显著差异。
本研究证实，糖尿病患者应使用更高的CC评分来提高CC诊断阻塞性疾病的特异性。EBT可在临床表现前对CAD进行无创诊断，使检测到CC的患者能得到更多治疗。这些结果表明，无症状糖尿病患者与无糖尿病的CAD患者具有相同的致动脉粥样硬化负担。无症状糖尿病患者中CC的高患病率支持积极管理糖尿病及相关危险因素的必要性。
