Ahluwalia G, Jain P, Chugh S K, Wasir H S, Kaul U
Department of Cardiology, All India Institute of Medical Sciences, New Delhi.
Int J Cardiol. 1995 Feb;48(2):147-53. doi: 10.1016/0167-5273(94)02233-9.
Twenty male diabetic patients (age range, 40-60 years) with normal autonomic function were studied to determine the prevalence of silent myocardial ischemia on exercise as well as ambulatory electrocardiography. The presence and extent of silent myocardial ischemia was also correlated with the severity of atherosclerotic coronary artery disease as determined by coronary angiography. A cohort of 20 matched non-diabetic patients were also included in the study. Silent myocardial ischemia was detected in 50% of the diabetic patients on exercise electrocardiography and in 35% on ambulatory electrocardiography compared with 10% and 5% in non-diabetics by the two methods, respectively (P < 0.01 and P < 0.05, respectively). On exercise testing in diabetic patients, silent myocardial ischemia was detected in 64% of the patients with three-vessel disease, 50% of the patients with two-vessel disease and 20% of the patients with one-vessel disease whereas in non-diabetic patients silent myocardial ischemia was detected in only 18% of the patients with three-vessel disease (P < 0.05) and in none of the patients with two- or one-vessel disease. On ambulatory electrocardiography, only patients (both diabetic and non-diabetic) with three-vessel disease manifested silent myocardial ischemia. Total ischemic burden was similar in both the diabetic and non-diabetic patients. We conclude that silent myocardial ischemia occurs in diabetic patients with coronary artery disease more frequently even in the absence of autonomic dysfunction and the prevalence of silent myocardial ischemia is higher in patients with severe degree of coronary artery disease.
对20名自主神经功能正常的男性糖尿病患者（年龄范围40 - 60岁）进行研究，以确定运动及动态心电图检查时无症状性心肌缺血的发生率。无症状性心肌缺血的存在及程度还与冠状动脉造影所确定的动脉粥样硬化性冠状动脉疾病的严重程度相关。该研究还纳入了20名匹配的非糖尿病患者。通过运动心电图检查，糖尿病患者中有50%检测到无症状性心肌缺血，动态心电图检查中有35%检测到；相比之下，非糖尿病患者通过这两种方法检测到无症状性心肌缺血的比例分别为10%和5%（P分别<0.01和P<0.05）。在糖尿病患者的运动试验中，三支血管病变患者中有64%检测到无症状性心肌缺血，两支血管病变患者中有50%，单支血管病变患者中有20%；而在非糖尿病患者中，三支血管病变患者中只有18%检测到无症状性心肌缺血（P<0.05），两支或单支血管病变患者中均未检测到。在动态心电图检查中，只有三支血管病变的患者（糖尿病和非糖尿病患者）表现出无症状性心肌缺血。糖尿病患者和非糖尿病患者的总缺血负荷相似。我们得出结论，即使在没有自主神经功能障碍的情况下，冠状动脉疾病的糖尿病患者中无症状性心肌缺血也更频繁发生，且冠状动脉疾病严重程度较高的患者中无症状性心肌缺血的发生率更高。
