Charpentier G, Riveline J P, Lardoux H, Mathieu E, Requeda E, Varroud-Vial M
Service d'endocrino-diabétologie, centre hospitalier sud-francilien, Corbeil.
Arch Mal Coeur Vaiss. 2000 Dec;93 Spec No 4:25-32.
Non-Invasive coronary investigations are positive in 12 to 52% (average 22%) of type II diabetics, and 11 to 30% (average 17%) of type i diabetics. These statistics vary according to bias of recruitment. Haemodynamic lesions are found at coronary angiography in 35 to 80% of patients who have at least one positive non-invasive investigation. Nine to 12% of diabetics have silent myocardial ischaemia (SMI) confirmed by coronary angiography, compared with 1.3 to 5.3% of non-diabetic controls paired for age and sex. The higher frequency of SMI in diabetics seems to be mostly due to the increased frequency of ischaemic heart disease in diabetics. The importance of cardiac autonomic neuropathy (CAN) in SMI is controversial. The risk factors associated with SMI are those usually associated with coronary artery disease: age, masculine gender, hypercholesterolaemia, hypertriglyceridaemia, hypertension, smoking, a family history of cardiovascular disease, insulin therapy (for type II diabetes), proteinuria, retinopathy, peripheral occlusive arterial disease.... The French recommendations for investigating SMI seem to be contradictory. A single risk score in a given patient could help codify the investigation of SMI in diabetics, but this type of score has not yet been validated.
在II型糖尿病患者中，非侵入性冠状动脉检查结果呈阳性的比例为12%至52%（平均22%），在I型糖尿病患者中为11%至30%（平均17%）。这些统计数据因招募偏差而有所不同。在至少一项非侵入性检查呈阳性的患者中，35%至80%在冠状动脉造影时发现血流动力学病变。经冠状动脉造影证实，9%至12%的糖尿病患者存在无症状心肌缺血（SMI），而年龄和性别匹配的非糖尿病对照者中这一比例为1.3%至5.3%。糖尿病患者中SMI的较高发生率似乎主要归因于糖尿病患者缺血性心脏病发生率的增加。心脏自主神经病变（CAN）在SMI中的重要性存在争议。与SMI相关的危险因素通常是那些与冠状动脉疾病相关的因素：年龄、男性、高胆固醇血症、高甘油三酯血症、高血压、吸烟、心血管疾病家族史、胰岛素治疗（针对II型糖尿病）、蛋白尿、视网膜病变、外周动脉闭塞性疾病……法国关于SMI检查的建议似乎相互矛盾。为特定患者制定单一风险评分可能有助于规范糖尿病患者SMI的检查，但此类评分尚未得到验证。
