Department of Endocrinology-Diabetology-Nutrition, Paris-Nord University, Jean Verdier Hospital, AP-HP, avenue du 14-juillet, 93143 Bondy cedex, France.
Diabetes Metab. 2010 Apr;36(2):91-6. doi: 10.1016/j.diabet.2010.01.001. Epub 2010 Feb 26.
Despite the intensified control of risk factors, silent myocardial ischaemia (SMI) is still a frequent complication of diabetes that is also associated with a higher risk of cardiac events. The objectives of this review are to summarize the importance of screening for SMI in a subset of asymptomatic diabetic patients. There is evidence that screening markedly improves the evaluation of cardiovascular risk compared with the usual risk scores. New markers, validated by large-scale studies, are needed to help in identifying the patients with silent coronary stenoses, thereby lowering the number of screened patients. Some indications of benefit with revascularization in patients with silent coronary stenoses are also available. Although it is not yet time to stop screening diabetic patients for SMI, such screening should focus on patients who are at high or intermediate cardiovascular risk. Guidelines need to be updated to increase the value of screening.
尽管风险因素的控制力度不断加大，但无症状性心肌缺血（SMI）仍是糖尿病的常见并发症，也与更高的心脏事件风险相关。本综述的目的是总结对无症状糖尿病患者亚组进行 SMI 筛查的重要性。有证据表明，与常用风险评分相比，筛查可显著改善心血管风险评估。需要新的、经过大规模研究验证的标志物来帮助识别无症状性冠状动脉狭窄患者，从而减少筛查患者数量。对无症状性冠状动脉狭窄患者进行血运重建也有一些获益的迹象。尽管现在还不是停止对糖尿病患者进行 SMI 筛查的时候，但这种筛查应该集中在具有高或中心血管风险的患者身上。需要更新指南以增加筛查的价值。
