Department of Endocrinology and Metabolism, Osaka University, Suita, Japan.
Diabetes Care. 2010 Nov;33(11):2320-6. doi: 10.2337/dc09-2370. Epub 2010 Aug 19.
Individuals with type 2 diabetes are at high risk for cardiovascular events. We evaluated the prognostic value of gated myocardial perfusion single-photon computed tomography (SPECT) for asymptomatic diabetic patients in a Japanese population.
Asymptomatic patients (n=485) aged≥50 years with either a maximal carotid artery intima-media thickness of ≥1.1 mm, or a urinary albumin ≥30 mg/g creatinine or who had at least two of the following, abdominal obesity, low HDL cholesterol, high triglyceride levels, and hypertension, were enrolled at 50 institutions. The patients were evaluated using gated SPECT with the stress-rest protocol and followed up for 3 years.
During the follow-up period, 62 (13%) events occurred, including 5 cardiac deaths and 57 cardiovascular events. Patients with summed stress scores (SSS) of ≥9 had a significantly higher incidence (of either death or cardiovascular events) than those with SSS scores of <9 (23 vs. 12%; P=0.009). Multivariate Cox regression analysis showed that significant variables were SSS≥9, a low estimated glomerular filtration rate, and being a current smoker. Univariate Cox regression analysis showed that ticlopidine and insulin use are potent medical modulators of cardiovascular events.
The incidences of cardiovascular events and death were significantly high in a select population of type 2 diabetic patients with SPECT abnormalities. A targeted treatment strategy is required for asymptomatic but potentially high-risk patients with type 2 diabetes.
2 型糖尿病患者发生心血管事件的风险较高。我们评估了门控心肌灌注单光子发射计算机断层扫描（SPECT）对日本人群中无症状糖尿病患者的预后价值。
年龄≥50 岁、颈动脉内膜中层厚度最大≥1.1 毫米或尿白蛋白≥30mg/g 肌酐或至少有以下两种情况的无症状患者（n=485），腹部肥胖、低 HDL 胆固醇、高甘油三酯水平和高血压，在 50 家机构入组。患者采用门控 SPECT 进行应激-休息方案评估，并随访 3 年。
在随访期间，62 例（13%）发生了 62 例（13%）事件，包括 5 例心脏死亡和 57 例心血管事件。总和应激评分（SSS）≥9 的患者的发生率（死亡或心血管事件）明显高于 SSS 评分<9 的患者（23%比 12%；P=0.009）。多变量 Cox 回归分析显示，显著变量是 SSS≥9、肾小球滤过率估计值低和当前吸烟。单变量 Cox 回归分析表明，噻氯匹定和胰岛素的使用是心血管事件的有效药物调节因素。
在 SPECT 异常的 2 型糖尿病患者中，心血管事件和死亡的发生率明显较高。需要对无症状但有潜在高风险的 2 型糖尿病患者采取针对性的治疗策略。
