无症状2型糖尿病患者心电图异常的评估
Evaluation of ECG Abnormalities in Patients with Asymptomatic Type 2 Diabetes Mellitus.
作者信息
Gupta Sahil, Gupta Rajeev Kumar, Kulshrestha Malini, Chaudhary Rajib Ratna
机构信息
Postgraduate Student, Department of General Medicine, Rohilkhand Medical College, Bareilly, Uttar Pradesh, India.
Assistant Professor, Department of General Medicine, Rohilkhand Medical College, Bareilly, Uttar Pradesh, India.
出版信息
J Clin Diagn Res. 2017 Apr;11(4):OC39-OC41. doi: 10.7860/JCDR/2017/24882.9740. Epub 2017 Apr 1.
INTRODUCTION
Diabetes Mellitus (DM) is the most common chronic disease. DM is considered a Cardiovascular Disease (CVD) risk equivalent. Its macrovascular complications are associated with two-fold increased risk of premature atherosclerotic CVD. Most of the diabetics with cardiovascular involvement are asymptomatic. Electro Cardio Graph (ECG) abnormalities are found to be predictors of silent ischaemia in asymptomatic persons. An abnormal ECG response is associated with statistically significant high risk for cardiac mortality and morbidity.
AIM
The aim of the study was to evaluate ECG changes in asymptomatic Type 2 DM patients.
MATERIALS AND METHODS
A cross-sectional comparative study was conducted in a tertiary care hospital in North India. One hundred diabetics presenting to Medicine OPD/IPD were included in the study who had no symptoms of heart disease and no diabetic complications. Fifty person with age and sex matched controls were included in the study. Relevant history and physical examination findings were recorded in a protocol. The variables studied were: gender, age, smoking, physical activity, and waist circumference, Body Mass Index (BMI) and blood pressure. Resting ECG was recorded.
RESULTS
Mean age of asymptomatic diabetic patients was 50.3±11.90 years (age range 25-75 years). In this study, none of the control group had ECG abnormality whereas, 26% asymptomatic diabetics had ECG abnormalities. Most of the asymptomatic cases with ECG changes had 5-10 year of duration of diabetes mellitus; 70% patients with ECG changes had poor glycaemic control, increased triglyceride and decreased High Density Lipoprotein (HDL) levels. Most common abnormality observed was ST-T changes, followed by Left Atrial Enlargement (LAE), Left Ventricular Hypertrophy (LVH), Left Bundle Branch Block (LBBB) and Right Bundle Branch Block (RBBB).
CONCLUSION
ECG changes are present in quarter of asymptomatic Type 2 DM patients. However, nonspecific ST-T changes, LVH and LAE are common.
引言
糖尿病（DM）是最常见的慢性疾病。糖尿病被视为心血管疾病（CVD）风险等同情况。其大血管并发症与过早发生动脉粥样硬化性心血管疾病的风险增加两倍相关。大多数有心血管受累的糖尿病患者无症状。心电图（ECG）异常被发现是无症状人群隐匿性缺血的预测指标。异常的心电图反应与心脏死亡率和发病率的统计学显著高风险相关。
目的
本研究的目的是评估无症状2型糖尿病患者的心电图变化。
材料与方法
在印度北部的一家三级护理医院进行了一项横断面比较研究。纳入100名到内科门诊/住院部就诊的糖尿病患者，他们没有心脏病症状且无糖尿病并发症。50名年龄和性别匹配的对照者也纳入研究。按照方案记录相关病史和体格检查结果。研究的变量包括：性别、年龄、吸烟、身体活动、腰围、体重指数（BMI）和血压。记录静息心电图。
结果
无症状糖尿病患者的平均年龄为50.3±11.90岁（年龄范围25 - 75岁）。在本研究中，对照组无一例心电图异常，而26%的无症状糖尿病患者有心电图异常。大多数有心电图变化的无症状病例糖尿病病程为5 - 10年；70%有心电图变化的患者血糖控制不佳，甘油三酯升高且高密度脂蛋白（HDL）水平降低。观察到的最常见异常是ST - T改变，其次是左心房扩大（LAE）、左心室肥厚（LVH）、左束支传导阻滞（LBBB）和右束支传导阻滞（RBBB）。
结论
四分之一的无症状2型糖尿病患者存在心电图变化。然而，非特异性ST - T改变、LVH和LAE较为常见。
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