Bax Jeroen J, Bonow Robert O, Tschöpe Diethelm, Inzucchi Silvio E, Barrett Eugene
Leiden University Medical Center, Leiden, The Netherlands.
J Am Coll Cardiol. 2006 Aug 15;48(4):754-60. doi: 10.1016/j.jacc.2006.04.077. Epub 2006 Jul 24.
Patients with diabetes, in particular patients with type 2 diabetes, are at a 2- to 4-fold higher risk of cardiovascular mortality compared with their nondiabetic peers. Patients with diabetes are also more likely to have silent ischemia and less likely to survive a myocardial infarction than nondiabetic patients. Recent studies with electron beam computed tomography (EBCT) have shown that subclinical atherosclerosis is common in patients with diabetes, and studies with myocardial perfusion scintigraphy (with single-photon emission computed tomography) or stress echocardiography have demonstrated that between 25% and 50% of asymptomatic diabetic patients have ischemia during exercise or pharmacological stress and that a substantial proportion of these patients go on to develop major cardiovascular events within several years. Clearly, asymptomatic diabetic patients include a subset of individuals at high risk of cardiovascular disease who would benefit from improved risk stratification beyond that possible with risk factor scoring systems alone. Single-photon emission computed tomography, stress echocardiography, and possibly EBCT or multi-slice computed tomography, are emerging as valuable diagnostic tools for identifying asymptomatic diabetic patients who might require early and aggressive intervention to manage their cardiovascular risk.
糖尿病患者，尤其是2型糖尿病患者，与非糖尿病同龄人相比，心血管疾病死亡率高出2至4倍。糖尿病患者也更易发生无症状性缺血，且与非糖尿病患者相比，心肌梗死后存活的可能性更小。最近使用电子束计算机断层扫描（EBCT）的研究表明，亚临床动脉粥样硬化在糖尿病患者中很常见，而使用心肌灌注闪烁扫描（单光子发射计算机断层扫描）或负荷超声心动图的研究表明，25%至50%的无症状糖尿病患者在运动或药物负荷期间存在缺血，并且这些患者中有很大一部分在几年内会发生重大心血管事件。显然，无症状糖尿病患者包括一部分心血管疾病高危个体，他们将受益于超越单纯危险因素评分系统的更完善的风险分层。单光子发射计算机断层扫描、负荷超声心动图，以及可能的EBCT或多层计算机断层扫描，正逐渐成为识别可能需要早期积极干预以管理心血管风险的无症状糖尿病患者的有价值的诊断工具。
