Emami Tayyebeh, Naeimei Zohreh, Salehifard Azita, Azizmohammadi Zahra, Iranpour Dariush, Kalantarhormozi Mohammadreza, Jafari Esmail, Gholamrezanezhad Ali, Assadi Majid
Bushehr University of Medical Sciences, School of Medicine, Bushehr Medical University Hospital, Department of Internal Medicine, Division of Endocrine Disorders, Bushehr, Iran
Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital, Department of Nuclear Medicine, Tehran, Iran
Mol Imaging Radionucl Ther. 2019 Jun 24;28(2):62-68. doi: 10.4274/mirt.galenos.2019.93798.
In light of increased risk of cardiovascular events and the poor prognosis of coronary artery disease (CAD) in diabetic versus non-diabetic patients and also with respect to the importance of early diagnosis of CAD in this status, the study was aimed to assess the importance of microalbuminuria in predicting silent myocardial ischemia (SMI) in patients with type 2 diabetes using myocardial perfusion imaging (MPI).
This study included 120 patients with diabetes type 2, but without previously known CAD or any cardiac symptoms that were stratified into two groups based on presence/absence of microalbuminuria. All participants underwent CAD evaluation using gated myocardial perfusion single-photon emission computed tomography (MPS) imaging. Other clinical and laboratory indices were also recorded
Studied population consisted of 84 males (70%) and 36 females (30%), totally 120 patients with mean age of 58.61±9.90). In total, asymptomatic ischemia was detected in 78 (65%) of the included diabetic patients. Stress induced ischemia was found in 56 patients (87.5%) of albumin+ (Alb) group and in 22 patients (39.3%) of Alb- group. The frequency of stress induced ischemia was 10.81 times higher in the patients with microalbuminuria compared to Alb- ones [p<0.001, Odds ratio: 10.81, 95% confidence interval: 4.33-26.99]. On the other hand, no relationship was found between the presence of stress induced ischemia and therapy type, diabetes duration, history of evident retinopathy, history of hypertension and also serum levels of hemoglobin A1c (p>0.05).
The current study showed that abnormal MPI findings are significantly more common in diabetic patients with microalbuminuria. With respect to low cost and availability of urine Alb detection tests, it might be as a biomarker for prediction of SMI in daibetic population.
鉴于糖尿病患者与非糖尿病患者相比心血管事件风险增加以及冠状动脉疾病（CAD）预后较差，同时考虑到在此状态下CAD早期诊断的重要性，本研究旨在评估微量白蛋白尿在使用心肌灌注成像（MPI）预测2型糖尿病患者无症状心肌缺血（SMI）中的重要性。
本研究纳入120例2型糖尿病患者，这些患者既往无已知CAD或任何心脏症状，根据是否存在微量白蛋白尿分为两组。所有参与者均接受门控心肌灌注单光子发射计算机断层扫描（MPS）成像进行CAD评估。还记录了其他临床和实验室指标。
研究人群包括84名男性（70%）和36名女性（30%），共120例患者，平均年龄为58.61±9.90岁。在纳入的糖尿病患者中，共有78例（65%）检测到无症状缺血。白蛋白阳性（Alb）组56例患者（87.5%）和Alb阴性组22例患者（39.3%）发现有应激诱导的缺血。与Alb阴性患者相比，微量白蛋白尿患者应激诱导缺血的发生率高10.81倍[p<0.001，优势比：10.81，95%置信区间：4.33 - 26.99]。另一方面，未发现应激诱导缺血的存在与治疗类型、糖尿病病程、明显视网膜病变史、高血压病史以及糖化血红蛋白血清水平之间存在关联（p>0.05）。
本研究表明，微量白蛋白尿的糖尿病患者MPI异常结果明显更为常见。鉴于尿Alb检测试验成本低且易于获得，它可能作为糖尿病患者SMI预测的生物标志物。
