长期 1 型糖尿病患者中的未诊断出的冠状动脉疾病。Dialong 研究。
Undiagnosed coronary artery disease in long-term type 1 diabetes. The Dialong study.
机构信息
Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
出版信息
J Diabetes Complications. 2019 May;33(5):383-389. doi: 10.1016/j.jdiacomp.2019.01.006. Epub 2019 Jan 31.
AIMS
We studied the total prevalence of obstructive coronary artery disease (CAD), undiagnosed CAD and absent CAD in persons with ≥45-year duration of type 1 diabetes (T1D) versus controls, and associations with mean HbA, LDL-cholesterol and blood pressure over 2-3 decades.
METHODS
We included 76% (n = 103) of all persons with T1D diagnosed ≤1970 attending a diabetes center and 63 controls without diabetes. We collected 20-30 years of HbA, LDL-cholesterol and blood pressure measurements. Participants without previously diagnosed coronary heart disease (CHD) underwent Computed Tomography Coronary Angiography (CTCA). Undiagnosed obstructive CAD was defined as any coronary stenosis >50% on CTCA, absent CAD as no detected plaque, and total obstructive CAD as either obstructive CAD on CTCA or previous CHD diagnosis.
RESULTS
The prevalence of undiagnosed, absent and obstructive CAD was 24% (21/88), 16% (14/88) and 35% (36/103) in T1D versus 10% (6/60), 50% (30/60) and 14% (9/63) in controls (all p < 0.05). Mean HbA was associated with undiagnosed obstructive CAD (OR 2.30 95% C.I. 1.13-4.69), while mean LDL-cholesterol was inversely associated with absent CAD (0.12, 0.04-0.43).
CONCLUSIONS
The prevalence of undiagnosed obstructive CAD was high (24%) in this cohort of long-term survivors with T1D. Mean LDL-cholesterol and HbA were associated with CAD.
目的
我们研究了病程≥45 年的 1 型糖尿病（T1D）患者与对照组相比，阻塞性冠状动脉疾病（CAD）、未诊断 CAD 和无 CAD 的总患病率，以及与 2-3 十年内平均 HbA、LDL-胆固醇和血压的相关性。
方法
我们纳入了 1970 年之前确诊的 T1D 患者的 76%（n=103），以及 63 名无糖尿病的对照组。我们收集了 20-30 年的 HbA、LDL-胆固醇和血压测量值。没有先前诊断出的冠心病（CHD）的参与者接受了计算机断层扫描冠状动脉造影（CTCA）。未诊断的阻塞性 CAD 定义为 CTCA 上任何冠状动脉狭窄>50%，无斑块的 CAD 定义为无检测到斑块，总阻塞性 CAD 定义为 CTCA 上的阻塞性 CAD 或先前的 CHD 诊断。
结果
在 T1D 患者中，未诊断、无和阻塞性 CAD 的患病率分别为 24%（21/88）、16%（14/88）和 35%（36/103），而在对照组中分别为 10%（6/60）、50%（30/60）和 14%（9/63）（均 p<0.05）。平均 HbA 与未诊断的阻塞性 CAD 相关（OR 2.30，95%CI 1.13-4.69），而平均 LDL-胆固醇与无 CAD 呈负相关（0.12，0.04-0.43）。
结论
在该长期生存的 T1D 患者队列中，未诊断的阻塞性 CAD 的患病率较高（24%）。平均 LDL-胆固醇和 HbA 与 CAD 相关。
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