Negrusz-Kawecka M, Moszczyńska-Stulin J, Zytkiewicz-Jaruga D, Salomon P
Katedry i Kliniki Kardiologii Akademii Medycznej, Wrocławiu.
Pol Merkur Lekarski. 1997 Aug;3(14):53-6.
Early detection of silent ischaemia plays an important role in prevention of sudden cardiac death and acute myocardial infarction. More frequent occurrence of silent ischaemia in patients with diabetes mellitus and manifestations of ischaemic heart disease has been relayed in several studies. No studies aimed at frequency of occurrence of silent ischaemia in diabetic patients without clinical symptoms of ischaemic heart disease have been performed yet. Objectives of this study were the examination of the latter case. This study involved 67 patients with diabetes mellitus without clinical symptoms of ischaemic heart disease. The average duration time of diabetes mellitus was 11 years. The patients were divided in two groups. The first group included 26 patients with insulin dependent diabetes mellitus. The second group included 41 patients with non insulin dependent diabetes mellitus. The first control group consisted of 35 non diabetic patients with ischaemic heart disease, and the second control group consisted of 22 healthy volunteers. 24-hours ambulatory Holter monitoring and ECG exercise test were performed in all subjects. The diagnosis of silent ischaemia was established in patients with positive results of both examinations in ECG-records without any following pain. In case of only one positive results the dipyridamole stress echocardiography test with ECG was carried out to prove the diagnosis. It was proved, that silent ischaemia occurs in 19.2% of patients with insulin dependent diabetes mellitus and in 22% non insulin diabetic patients. No statistic differences between frequency of silent ischaemia occurrence in both groups were revealed. The application of 24-hours Holter monitoring combined with ECG-exercise stress test seems to be the best method in early recognition of silent ischaemia in diabetic patients.
无症状性缺血的早期检测在预防心源性猝死和急性心肌梗死方面发挥着重要作用。多项研究报告称，糖尿病患者和缺血性心脏病患者中无症状性缺血的发生率更高。然而，尚未有针对无缺血性心脏病临床症状的糖尿病患者无症状性缺血发生率的研究。本研究的目的是检查后一种情况。本研究纳入了67例无缺血性心脏病临床症状的糖尿病患者。糖尿病的平均病程为11年。患者被分为两组。第一组包括26例胰岛素依赖型糖尿病患者。第二组包括41例非胰岛素依赖型糖尿病患者。第一对照组由35例患有缺血性心脏病的非糖尿病患者组成，第二对照组由22名健康志愿者组成。对所有受试者进行了24小时动态心电图监测和心电图运动试验。对于心电图记录中两项检查结果均为阳性且无后续疼痛的患者，诊断为无症状性缺血。若只有一项阳性结果，则进行双嘧达莫负荷超声心动图试验并结合心电图以证实诊断。结果证明，胰岛素依赖型糖尿病患者中无症状性缺血的发生率为19.2%，非胰岛素依赖型糖尿病患者中为22%。两组间无症状性缺血发生率无统计学差异。24小时动态心电图监测结合心电图运动负荷试验似乎是早期识别糖尿病患者无症状性缺血的最佳方法。
