Xiao-Rong Zhu, Hui-Rong Zhang, Mei Li, Zhen Zhou, Wei Liu, Jing Lu, Guang-Ran Yang, Jian-Bo Zhou, Jin-Kui Yang
Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University.
Department of Nuclear Medicine Department, Beijing Tongren Hospital.
Medicine (Baltimore). 2019 May;98(20):e15618. doi: 10.1097/MD.0000000000015618.
To explore the prevalence and risk factors of silent myocardial ischemia (SMI) detected by using single photon emission computed tomography (SPECT) in Chinese asymptomatic patients with type 2 diabetes (T2D).In this hospital-based retrospective study, 821 T2D patients who were screened for SMI detected by stress myocardial perfusion imaging using SPECT between June 2014 and July 2016 were investigated. Clinical indicators were compared between the patients with SMI and controls without SMI. Risk factors for SMI were evaluated by univariate and multivariate analysis.In this study, there were 131 patients with SMI in asymptomatic diabetes and the prevalence of SMI was 21.3% of 614 individuals. Logistic regression analysis indicated that diabetic retinopathy (OR = 1.474, 95%CI: 1.113-1.951, P = .007), male gender (OR = 1.805, 95%CI: 1.183-2.747, P = .006), and low-density lipoprotein (LDL) cholesterol (OR = 1.298, 95%CI: 1.042-1.615, P = .02) were risk factors associated with SMI. Besides, the prevalence of SMI increased in associated with the progression of retinopathy (P = .041). The percentage of SMI diagnosed in patients with no diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) were 18.5% (75/405), 25.2% (37/147), and 30.6% (19/62), respectively. The percentage of SMI in male (24.5%, 85/347) was higher than that in female (17.2%, 46/267), P = .029.Physicians should be aware of these conditions when examining male patients with type 2 diabetes, especially with DR and/or high level of low-density lipoprotein cholesterol (LDL cholesterol), even if otherwise asymptomatic. A routine screening for SMI may thus be considered advisable in these patients.
探讨中国无症状2型糖尿病（T2D）患者中使用单光子发射计算机断层扫描（SPECT）检测到的无症状心肌缺血（SMI）的患病率及危险因素。在这项基于医院的回顾性研究中，调查了2014年6月至2016年7月期间821例接受SPECT负荷心肌灌注成像筛查SMI的T2D患者。比较了有SMI患者和无SMI对照者的临床指标。通过单因素和多因素分析评估SMI的危险因素。本研究中，无症状糖尿病患者中有131例发生SMI，在614例个体中SMI患病率为21.3%。逻辑回归分析表明，糖尿病视网膜病变（OR = 1.474，95%CI：1.113 - 1.951，P = 0.007）、男性（OR = 1.805，95%CI：1.183 - 2.747，P = 0.006）和低密度脂蛋白（LDL）胆固醇（OR = 1.298，95%CI：1.042 - 1.615，P = 0.02）是与SMI相关的危险因素。此外，SMI患病率随视网膜病变进展而增加（P = 0.041）。无糖尿病视网膜病变（NDR）、非增殖性糖尿病视网膜病变（NPDR）和增殖性糖尿病视网膜病变（PDR）患者中诊断出SMI的百分比分别为18.5%（75/405）、25.2%（37/147）和30.6%（19/62）。男性中SMI的百分比（24.5%，85/347）高于女性（17.2%，46/267），P = 0.029。医生在检查2型糖尿病男性患者时应注意这些情况，尤其是患有糖尿病视网膜病变和/或低密度脂蛋白胆固醇（LDL胆固醇）水平高的患者，即使他们没有其他症状。因此，对于这些患者，可考虑进行SMI的常规筛查。
