Rutter Martin K, Wahid Shahid T, McComb Janet M, Marshall Sally M
Department of Medicine, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom.
J Am Coll Cardiol. 2002 Jul 3;40(1):56-61. doi: 10.1016/s0735-1097(02)01910-1.
The aim of this study was to investigate the relationships between future coronary heart disease (CHD) events and baseline silent myocardial ischemia (SMI) and microalbuminuria (MA) in subjects with type 2 diabetes (T2D) free from known CHD.
Coronary heart disease is often asymptomatic in subjects with diabetes. There is limited information on the prognostic value of SMI and MA in this group.
Eighty-six patients with T2D and no history of CHD were studied (43 with MA individually matched with 43 normoalbuminuric patients; mean [SD] age 62 [+/-7] years, 62 men). Metabolic assessment, three timed overnight urine collections for albumin excretion rate, a treadmill exercise test and ankle brachial index (ABI) were performed at baseline. Patients were followed for 2.8 years.
Forty-five (52%) patients had SMI during treadmill testing. At review, there had been 23 coronary (CHD) events in 15 patients. Univariate Cox regression analysis showed that CHD events were significantly related to baseline ABI (p = 0.014), SMI (p = 0.020), MA (p = 0.046), 10-year Framingham CHD risk >30% (p = 0.035) and fibrinogen (p = 0.026). In multivariate analysis, SMI was the strongest independent predictor of CHD events (p = 0.008); risk ratio (95% confidence interval) for SMI: 21 (2 to 204). In the prediction of CHD events, SMI showed higher sensitivity and positive predictive value than MA or Framingham calculated CHD risk.
The presence of baseline SMI and MA are associated with future CHD events in asymptomatic patients with T2D and may be of practical use in risk stratification.
本研究旨在探讨无已知冠心病的2型糖尿病（T2D）患者未来冠心病（CHD）事件与基线无症状心肌缺血（SMI）及微量白蛋白尿（MA）之间的关系。
冠心病在糖尿病患者中常无症状。关于该组患者中SMI和MA的预后价值的信息有限。
对86例无冠心病病史的T2D患者进行研究（43例MA患者与43例正常白蛋白尿患者个体匹配；平均[标准差]年龄62[±7]岁，男性62例）。在基线时进行代谢评估、三次定时夜间尿白蛋白排泄率收集、平板运动试验和踝臂指数（ABI）测定。对患者随访2.8年。
45例（52%）患者在平板运动试验期间出现SMI。复查时，15例患者发生了23次冠心病（CHD）事件。单因素Cox回归分析显示，CHD事件与基线ABI（p = 0.014）、SMI（p = 0.020）、MA（p = 0.046）、10年弗雷明汉姆冠心病风险>30%（p = 0.035）和纤维蛋白原（p = 0.026）显著相关。多因素分析中，SMI是CHD事件最强的独立预测因子（p = 0.008）；SMI的风险比（95%置信区间）：21（2至204）。在CHD事件预测中，SMI比MA或弗雷明汉姆计算的冠心病风险显示出更高的敏感性和阳性预测值。
基线SMI和MA的存在与无症状T2D患者未来CHD事件相关，可能在风险分层中具有实际应用价值。
