糖尿病前期患者的无症状心肌缺血与胰岛素抵抗的关系
Silent myocardial ischemia in prediabetics in relation to insulin resistance.
作者信息
Nasr Gamela, Sliem Hamdy
机构信息
Department of Cardiology Suez Canal University, Ismailia, Egypt.
出版信息
J Cardiovasc Dis Res. 2010 Jul;1(3):116-21. doi: 10.4103/0975-3583.70903.
BACKGROUND
Myocardial perfusion imaging (MPI) is a powerful diagnostic and prognostic tool for evaluating coronary artery disease (CAD). Several studies have shown Type 2 diabetics are at increased risk for having CAD. In addition, insulin resistance is generally considered to be of major importance in the pathophysiology of Type 2 diabetes mellitus. However, the area of screening prediabetics for CAD remains unclear. Given that glucose intolerance and insulin resistance precede the development of overt diabetes, these factors would be associated with CAD.
AIM
This study was designed to evaluate the state of myocardial perfusion in prediabetic adults detected by single photon emission computed tomography (SPECT) in relation to insulin resistance.
PATIENTS AND METHODS
A descriptive study was performed. Out of 113 consecutive prediabetic adults, 32 had insulin resistance (Group A) and 81 had insulin sensitivity (Group B). All were subjected to full medical history and clinical examination including blood pressure, waist circumference, and body mass index. Biochemical studies including lipids profile, fasting blood glucose, and homeostasis model assessments (HOMA) test. Exercise treadmill technetium (99mTC) sestamibi SPECT scintigraphy were done for assessment of myocardial perfusion assessed by summed difference score as well as occurrence of transient left ventricular dilatation.
RESULTS
Significant increase in summed difference score as well as transient left ventricular dilatation was observed in Group A than Group B. It is correlated with insulin resistance, and the correlation appears to be independent of glucose tolerance status and obesity. Similar correlations were observed with age, triglycerides, and waist circumference.
CONCLUSION
Prediabetics have myocardial perfusion defects which represent a pattern of cardiovascular risk. These are predominantly observed in prediabetics with increased HOMA IR and visceral obesity independent of glucose levels.
背景
心肌灌注成像（MPI）是评估冠状动脉疾病（CAD）的一种强大的诊断和预后工具。多项研究表明，2型糖尿病患者患CAD的风险增加。此外，胰岛素抵抗通常被认为在2型糖尿病的病理生理学中起主要作用。然而，对糖尿病前期患者进行CAD筛查的领域仍不明确。鉴于葡萄糖耐量异常和胰岛素抵抗先于显性糖尿病的发生，这些因素可能与CAD相关。
目的
本研究旨在评估通过单光子发射计算机断层扫描（SPECT）检测的糖尿病前期成年人的心肌灌注状态与胰岛素抵抗的关系。
患者和方法
进行了一项描述性研究。在113名连续的糖尿病前期成年人中，32人有胰岛素抵抗（A组），81人有胰岛素敏感性（B组）。所有患者均接受了完整的病史和临床检查，包括血压、腰围和体重指数。进行了生化研究，包括血脂谱、空腹血糖和稳态模型评估（HOMA）测试。进行运动平板锝（99mTC） sestamibi SPECT闪烁扫描，以通过总差异评分以及短暂性左心室扩张的发生情况评估心肌灌注。
结果
与B组相比，A组的总差异评分以及短暂性左心室扩张显著增加。它与胰岛素抵抗相关，并且这种相关性似乎独立于葡萄糖耐量状态和肥胖症。在年龄与甘油三酯、腰围之间也观察到类似的相关性。
结论
糖尿病前期患者存在心肌灌注缺陷，这代表了一种心血管风险模式。这些主要在HOMA-IR升高和内脏肥胖的糖尿病前期患者中观察到，且独立于血糖水平。
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