Gokcel A, Aydin M, Yalcin F, Yapar A F, Ertorer M E, Ozsahin A K, Muderrisoglu H, Aktas A, Guvener N, Akbaba M
Division of Endocrinology and Metabolism, Baskent University, Dadaloglu Mah Serin Evler 39 Sok No 6, 01250, Yuregir, Adana, Turkey.
Acta Diabetol. 2003 Dec;40(4):176-80. doi: 10.1007/s00592-003-0108-9.
The purpose of this study was to estimate the prevalence and risk factors of silent CAD in asymptomatic type 2 diabetic patients aged over 40 years. A total of 172 asymptomatic type 2 diabetic patients, mean age 54.42 years, with normal resting electrocardiogram were included in the study. Technetium-99m (Tc-99m) tetrofosmin cardiac single photon emission computed tomography myocardial scintigraphy with exercise testing or dipyridamole injection was performed on all patients. If this test was positive, coronary angiography was carried out and was considered to be positive with a stenosis of > or =70%. Abnormal perfusion pattern was found in 14 patients (8.14%). Significant coronary artery stenosis was found in 13 subjects (7.56%), confirming a high positive predictive value (92.86%) of this diagnostic procedure. A significant correlation was observed between silent CAD and male sex, retinopathy, hypertension, post-prandial blood glucose level, and low HDL-cholesterol level. Sex (OR=4.026; 95% CI, 1.187-13.659), hypertension (OR=5.564; 95% CI, 1.446-21.400) and retinopathy (OR=3.766; 95% CI, 1.096-12.948) were risk factors for CAD. Overall, 14.06% of asymptomatic male patients with type 2 diabetes mellitus presented silent CAD with significant angiographically documented coronary stenosis. This finding, along with the high positive predictive value of a noninvasive technique, indicates that routine screening for silent CAD would be useful in this patient subgroup especially when they have retinopathy or hypertension.
本研究旨在评估40岁以上无症状2型糖尿病患者隐匿性冠心病的患病率及危险因素。共有172例无症状2型糖尿病患者纳入研究，平均年龄54.42岁，静息心电图正常。所有患者均行锝-99m（Tc-99m）替曲膦心肌单光子发射计算机断层扫描心肌显像，采用运动试验或注射双嘧达莫。若该检查呈阳性，则进行冠状动脉造影，狭窄≥70%被视为阳性。14例患者（8.14%）发现灌注异常。13例受试者（7.56%）发现显著冠状动脉狭窄，证实该诊断方法具有较高的阳性预测值（92.86%）。隐匿性冠心病与男性、视网膜病变、高血压、餐后血糖水平及低高密度脂蛋白胆固醇水平之间存在显著相关性。性别（OR=4.026；95%CI，1.187-13.659）、高血压（OR=5.564；95%CI，1.446-21.400）和视网膜病变（OR=3.766；95%CI，1.096-12.948）是冠心病的危险因素。总体而言，14.06%的无症状男性2型糖尿病患者存在隐匿性冠心病，冠状动脉造影显示有显著狭窄。这一发现以及非侵入性技术的高阳性预测值表明，对该患者亚组进行隐匿性冠心病的常规筛查是有用的，尤其是当他们患有视网膜病变或高血压时。
