Kim Won Yong, Astrup Anne Sofie, Stuber Matthias, Tarnow Lise, Falk Erling, Botnar René M, Simonsen Cheryl, Pietraszek Lotte, Hansen Peter R, Manning Warren J, Andersen Niels T, Parving Hans-Henrik
Department of Cardiology, Skejby Hospital, Brendstrupgaardsvej, 8200 Aarhus N, Denmark.
Circulation. 2007 Jan 16;115(2):228-35. doi: 10.1161/CIRCULATIONAHA.106.633339. Epub 2006 Dec 26.
Patients with type 1 diabetes and nephropathy maintain an excess cardiovascular mortality compared with diabetic patients with normoalbuminuria. We sought to evaluate coronary and aortic atherosclerosis in a cohort of asymptomatic type 1 diabetic patients with and without diabetic nephropathy using cardiovascular magnetic resonance imaging.
In a cross-sectional study, 136 subjects with long-standing type 1 diabetes without symptoms or history of cardiovascular disease, including 63 patients (46%) with nephropathy and 73 patients with normoalbuminuria, underwent cardiovascular magnetic resonance imaging. All subjects underwent cardiac exercise testing and noninvasive tests for peripheral artery disease and autonomic neuropathy. Coronary artery stenoses were identified in 10% of subjects with nephropathy (versus 0% with normoalbuminuria; P=0.007). Coronary plaque burden, expressed as right coronary artery mean wall thickness (1.7+/-0.3 versus 1.3+/-0.2 mm; P<0.001) and maximum right coronary artery wall thickness (2.2+/-0.5 versus 1.6+/-0.3 mm; P<0.001), was greater in subjects with nephropathy. The prevalence of thoracic (3% versus 0%; P=0.28) and abdominal aortic plaque (22% versus 16%; P=0.7) was similar in both groups. Subjects with and without abdominal aortic plaques had similar coronary plaque burden.
In asymptomatic type 1 diabetes, cardiovascular magnetic resonance imaging reveals greater coronary plaque burden in subjects with nephropathy compared with those with normoalbuminuria.
与尿白蛋白正常的糖尿病患者相比，1型糖尿病肾病患者的心血管死亡率更高。我们试图使用心血管磁共振成像评估一组有无糖尿病肾病的无症状1型糖尿病患者的冠状动脉和主动脉粥样硬化情况。
在一项横断面研究中，136例患有长期1型糖尿病且无症状或无心血管疾病史的受试者接受了心血管磁共振成像检查，其中包括63例（46%）肾病患者和73例尿白蛋白正常的患者。所有受试者均接受了心脏运动试验以及外周动脉疾病和自主神经病变的无创检查。肾病患者中10%存在冠状动脉狭窄（尿白蛋白正常患者中为0%；P=0.007）。以右冠状动脉平均壁厚度（1.7±0.3对1.3±0.2 mm；P<0.001）和右冠状动脉最大壁厚度（2.2±0.5对1.6±0.3 mm；P<0.001）表示的冠状动脉斑块负荷，肾病患者更高。两组胸主动脉斑块（3%对0%；P=0.28）和腹主动脉斑块（22%对16%；P=0.7）的患病率相似。有无腹主动脉斑块的受试者冠状动脉斑块负荷相似。
在无症状1型糖尿病患者中，心血管磁共振成像显示，与尿白蛋白正常的患者相比，肾病患者的冠状动脉斑块负荷更大。
