四分之一的 2 型糖尿病患者的心肌梗死为无症状表现。
One quarter of total myocardial infarctions are silent manifestation in patients with type 2 diabetes mellitus.
机构信息
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Health Care Center, Kumamoto University, Kumamoto, Japan.
National Cerebral and Cardiovascular Center, Suita, Japan.
出版信息
J Cardiol. 2019 Jan;73(1):33-37. doi: 10.1016/j.jjcc.2018.05.017. Epub 2018 Jul 4.
BACKGROUND
Silent events with newly developed Q waves in electrocardiogram (ECG) [silent myocardial infarction (MI)] in diabetic patients is reported to be independently associated with an increased risk of fatal MI. However, the incidence rate of silent MI in diabetic patients has yet to be clarified. We sought to determine the incidence rate of first symptomatic MI and silent MI in diabetic patients.
METHODS
We conducted a prospective cohort study on patients enrolled in the Japanese primary prevention of atherosclerosis with aspirin for diabetes (JPAD) trial which was started in 2002. It is a randomized controlled trial to examine the efficacy of low-dose aspirin therapy for the primary prevention of atherosclerotic events in type 2 diabetic patients. No patients had Q waves in their ECG before entry to the JPAD trial. We followed-up 1825 patients until July 2015 after completion of the JPAD trial in 2008. The median follow-up period was 10.3 years. We collected 1648 patients' ECGs to identify patients with silent MI.
RESULTS
Symptomatic MI occurred in 65 patients and silent MI occurred in 22 patients. The incidence rate of symptomatic MI was 4.26 per 1000 patient-years and 1.44 for silent MI in diabetic patients. Thus, 25% of total MIs were silent. Cause-specific Cox proportional hazard model indicated that age (hazard ratio 1.06, 95% confidence interval; 1.03-1.10, p=0.0004) and long history of diabetes (1.00, 1.01-1.07, p=0.01) were independently associated with symptomatic MI, but these were not associated with silent MI.
CONCLUSIONS
We demonstrated that incidence rate of first silent MI and that proportion of silent MI to all MIs was 25% in diabetic patients without a history of atherosclerotic events. Diabetic patients frequently need ECG screening for detection of silent MI.
背景
心电图（ECG）中新出现的 Q 波表明有心肌梗死（MI）病史[无症状性心肌梗死（SMI）]的糖尿病患者，其发生致命性 MI 的风险增加。然而，糖尿病患者中无症状性 MI 的发生率尚不清楚。我们旨在明确糖尿病患者首次出现有症状性 MI 和无症状性 MI 的发生率。
方法
我们进行了一项前瞻性队列研究，研究对象为 2002 年开始的日本糖尿病患者阿司匹林预防动脉粥样硬化研究（JPAD）试验的入组患者。这是一项随机对照试验，旨在评估小剂量阿司匹林治疗 2 型糖尿病患者动脉粥样硬化性疾病的一级预防效果。所有患者在入组 JPAD 试验前心电图均无 Q 波。我们对 1825 例患者进行了随访，随访时间截至 2015 年 7 月，即 2008 年 JPAD 试验结束后。中位随访时间为 10.3 年。我们收集了 1648 例患者的心电图以确定无症状性 MI 患者。
结果
有症状性 MI 发生 65 例，无症状性 MI 发生 22 例。有症状性 MI 的发生率为每 1000 人年 4.26 例，糖尿病患者的无症状性 MI 发生率为 1.44 例。因此，25%的 MI 为无症状性。原因特异性 Cox 比例风险模型显示，年龄（风险比 1.06，95%置信区间：1.03-1.10，p=0.0004）和较长的糖尿病病史（1.00，1.01-1.07，p=0.01）与有症状性 MI 独立相关，但与无症状性 MI 无关。
结论
我们证实，无动脉粥样硬化病史的糖尿病患者首次发生无症状性 MI 的发生率和所有 MI 中无症状性 MI 的比例为 25%。糖尿病患者需要经常进行心电图筛查以发现无症状性 MI。
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