Ugur-Altun Betul, Altun Armagan, Guldiken Sibel, Tatli Ersan, Kara Mujdat, Tugrul Armagan
Department of Endocrinology and Metabolism, Trakya University, Edime, Turkey.
Angiology. 2007 Oct-Nov;58(5):535-42. doi: 10.1177/0003319707307765.
The authors investigated silent myocardial ischemia in unselected consecutive middle-aged asymptomatic patients with type 2 diabetes without any evidence of coronary heart disease documented by treadmill exercise test. Ninety asymptomatic patients with type 2 diabetes (48 men; mean age: 49 +/-6 years) were included in the study. Mean duration of diabetes in the study group was 4 +/-4.2 years (range 1 to 21 years); 38% of the study population, diabetes duration was only 1 year). All patients were subjected to treadmill exercise test with Bruce protocol. A positive test was noted in 4 of 90 (4%) study patients. Two male patients (4%) and 2 (4%) women patients developed exercise-induced ST-segment depression, but none had concomitant chest pain. Diabetics with silent myocardial ischemia were older (55 +/-3 years vs 49 +/-6 years, p = 0.04) than those without silent myocardial ischemia. Also, diabetics with silent myocardial ischemia had higher fibrinogen level (372 +/-51 vs 307 +/-71 mg/dL, p = 0.04) than diabetics without silent myocardial ischemia. In treadmill exercise test, diabetics with silent myocardial ischemia had lower total exercise time and peak workload (375 +/-30 vs 474 +/-115 seconds, p = 0.04; 7.3 +/-0.5 vs 8.9 +/-1.9, p = 0.04, respectively) than without silent myocardial ischemia. Insulin resistance is associated with a variety of atherosclerosis risk factors. Exercise test findings show increased cardiac sympathetic activity and parasympathetic withdrawal in increased insulin resistance.
作者对未经选择的连续中年无症状2型糖尿病患者进行了研究，这些患者经平板运动试验未发现任何冠心病证据。90例无症状2型糖尿病患者（48例男性；平均年龄：49±6岁）纳入研究。研究组糖尿病平均病程为4±4.2年（范围1至21年）；38%的研究人群糖尿病病程仅1年）。所有患者均按照Bruce方案进行平板运动试验。90例研究患者中有4例（4%）试验结果为阳性。2例男性患者（4%）和2例女性患者（4%）出现运动诱发的ST段压低，但均无胸痛症状。有隐匿性心肌缺血的糖尿病患者比无隐匿性心肌缺血的患者年龄更大（55±3岁对49±6岁，p = 0.04）。此外，有隐匿性心肌缺血的糖尿病患者纤维蛋白原水平高于无隐匿性心肌缺血的糖尿病患者（372±51对307±71mg/dL，p = 0.04）。在平板运动试验中，有隐匿性心肌缺血的糖尿病患者总运动时间和峰值工作量低于无隐匿性心肌缺血的患者（分别为375±30对474±115秒，p = 0.04；7.3±0.5对8.9±1.9，p = 0.04）。胰岛素抵抗与多种动脉粥样硬化危险因素相关。运动试验结果显示，胰岛素抵抗增加时心脏交感神经活动增强和副交感神经活动减弱。
