Murray D P, O'Brien T, Mulrooney R, O'Sullivan D J
University Department of Medicine, Cork Regional Hospital, Wilton, Cork, Ireland.
Diabet Med. 1990 Aug;7(7):580-4. doi: 10.1111/j.1464-5491.1990.tb01452.x.
The incidence and mechanism of painless myocardial ischaemia on exercise testing in diabetic patients is not clear. Therefore, two studies were performed. Retrospectively, all exercise tests carried out in our hospital during the past 5 years were reviewed for silent ischaemia. Prospectively, diabetic patients with known or suspected coronary artery disease underwent autonomic function testing and a second exercise test. Of 1653 exercise tests reviewed, 247 were positive (ST depression greater than 0.1 mV). Of the 29 diabetic patients with positive tests 20 (69%) had painless ST depression, compared with 77 (35%) of the 218 non-diabetic patients (p less than 0.001). The diabetic patients with painful and painless ST depression were comparable for age, sex, therapy, but the 20 with no pain on exercise testing had a longer duration of diabetes and a higher incidence of microvascular complications than the 9 with pain (70 vs 22%, p less than 0.05). In the prospective study, 12 of 30 diabetic patients with positive exercise tests had pain in association with ST depression and 18 had no pain. Six patients had mild and 12 severe autonomic neuropathy on formal testing. Twelve had no autonomic dysfunction. Eleven (92%) of 12 patients with severe neuropathy had painless ST depression, compared with 7 (39%) of 18 without severe neuropathy (p less than 0.01). Thus, silent myocardial ischaemia on exercise testing is common among patients with diabetes mellitus and is associated with severe autonomic dysfunction.
糖尿病患者运动试验中无痛性心肌缺血的发生率及机制尚不清楚。因此，开展了两项研究。回顾性地，对我院过去5年进行的所有运动试验进行了无症状缺血情况的审查。前瞻性地，对已知或疑似患有冠状动脉疾病的糖尿病患者进行了自主神经功能测试及第二次运动试验。在审查的1653项运动试验中，247项呈阳性（ST段压低大于0.1mV）。在29例试验阳性的糖尿病患者中，20例（69%）有ST段无痛性压低，相比之下，218例非糖尿病患者中有77例（35%）（p<0.001）。有疼痛和无痛性ST段压低的糖尿病患者在年龄、性别、治疗方面具有可比性，但运动试验时无痛的20例患者糖尿病病程更长，微血管并发症发生率高于有疼痛的9例患者（70%对22%，p<0.05）。在前瞻性研究中，30例运动试验阳性的糖尿病患者中有12例在ST段压低时有疼痛，18例无疼痛。经正式测试，6例患者有轻度自主神经病变，12例有严重自主神经病变。12例无自主神经功能障碍。12例严重神经病变患者中有11例（92%）有ST段无痛性压低，相比之下，18例无严重神经病变患者中有7例（39%）（p<0.01）。因此，运动试验中的无症状心肌缺血在糖尿病患者中很常见，且与严重自主神经功能障碍相关。
