Department of Experimental and Internal Medicine Lanzara-Magrassi, Center of Cardiovascular Excellence, Second University of Naples, Via F. Petrarca, 64, I-80122, Naples, Italy.
Diab Vasc Dis Res. 2012 Jan;9(1):10-7. doi: 10.1177/1479164111426439. Epub 2011 Nov 7.
Non-invasive testing often does not identify coronary artery disease (CAD) in diabetic subjects. This study was designed in order to examine the prevalence of CAD in a cohort of asymptomatic type 2 diabetic patients at high cardiovascular risk and negative nuclear imaging, using multi-slice computed tomography (MSCT) angiography.
In total, 770 type 2 diabetic patients were screened from January 2008 through July 2010. Of these, 132 Caucasians with diabetic nephropathy and asymptomatic for angina were eligible for a cross-sectional study. Patients underwent MSCT after ischaemia was excluded by myocardial Single Photon Emission Computed Tomography (SPECT) at rest and after dynamic exercise. When obstructive plaques were found (≥ 50% lumen narrowing), patients were sent to conventional coronary angiography (CCA).
Six subjects were not included in the analysis because of motion artefacts. MSCT was positive for CAD in 114 patients (90%). Within patients with positive MSCT, 60 (48% of all) showed one or more obstructive plaques. CCA confirmed significant stenosis (≥ 50%) in 48 of these 60 patients (80%). Some 21 (35%) showed stenosis ≥ 75% and were submitted to the revascularisation procedure.
MSCT seems to better identify CAD than myocardial SPECT in asymptomatic patients with type 2 diabetes and diabetic nephropathy.
无创检查通常无法识别糖尿病患者的冠状动脉疾病（CAD）。本研究旨在通过多层螺旋 CT 血管造影（MSCT）检查，在患有 2 型糖尿病且伴有糖尿病肾病、无心绞痛症状但心血管风险较高的患者队列中，检测 CAD 的患病率。
2008 年 1 月至 2010 年 7 月期间共筛查了 770 例 2 型糖尿病患者，其中 132 例白种人伴糖尿病肾病且无症状性心绞痛患者符合横断面研究的入选标准。在心肌单光子发射计算机断层扫描（SPECT）检查排除缺血后，患者接受 MSCT 检查。当发现阻塞性斑块（≥50%管腔狭窄）时，患者被送往常规冠状动脉造影（CCA）。
6 名患者因运动伪影而未纳入分析。114 例患者的 MSCT 检查结果为 CAD 阳性（90%）。在 MSCT 检查阳性的患者中，有 60 例（所有患者的 48%）存在一个或多个阻塞性斑块。CCA 证实这些 60 例患者中的 48 例（80%）有明显狭窄（≥50%）。其中 21 例（35%）狭窄≥75%，并接受了血运重建手术。
与心肌 SPECT 相比，MSCT 似乎能更好地识别 2 型糖尿病伴糖尿病肾病患者无症状性 CAD。
