老年NIDDM患者缺血性心脏病的无创早期诊断及其研究

EARLY DIAGNOSIS AND INVESTIGATION OF ISCHEMIC HEART DISEASE IN AGED NIDDM PATIENTS

本文对500例休息时12导联ECG检查正常的NIDDM病人进行平板运动ECG、平板运动^(99M)Tc-MIBI ECT心肌显像、24小时动态ECG、血脂、血糖、血清胰岛素、24小时尿蛋白、肾个球滤过率、体重指数及眼底检查,结果发现500例NIDDM病人ECT心肌显像检查有明显心肌缺血者56例(A组),其中16例造影证实冠状动咏狭窄>75％(阳性)者15例,特异性93.8％;轻度心肌缺血者49例(B组),其中12例冠咏造影阳性者6例,特异性50％;无心肌缺血者395例(C组),其中5例冠脉造影阳性者为0。且A组的平均糖尿病病程、总胆固醇、空腹血糖及胰岛素、糖化血红蛋白、24小时尿蛋白和增殖性视网膜病变的发生率较B组及C组均明显升高(P<0.05);GFR则明显降低(P<0.05)。平板运动^(99M)Tc-MIBI ECT心肌显像缺血性心脏病的阳性率(A组+B组为105/500,21％)明显高于平板运动ECG(30/500,6％)及24小时动态ECG(4/500,0.8％),(P均<0.05)。

In order to make early diagnosis of the ischemic heart disease in the aged NIDDM patients. 500 patients underwent a series of examinations including maximal plate exercise with 59M Tc-MIBI ECT myocardiography. maximal plate exercise ECG and 24-hour ambulatory ECG. The serum lipid. glucose and insulin levels, daily urine protein, glomerular filtration rate,body weight index and eyeground were also studied. The results showed that 56 patients had obvious myocardial ischemia (group A),49 patients had slight myocardial ischemia (group B)and 395 patients were free from myocardial ischemia (group C). With positive 59MTc-MIBI ECT myocardiography, 15 among 16 patients in group A and 6 among 12 patients in group B and none among 5 in group C showed coronary artery narrowing in coronary radiography. The average course of DM,serum total cholesterol,fasting serum glucose and insulin, glucosylated hemoglobin.daily urine protein and the incidence of proliferative retinopathy of group A were higher than those of group B or C(P<0. 05). However.the gromerular filtration rate of group A was lower than that of group B or C(P<0. 05). The results imply that the sensitivity of maximal plate exercise with 59MTc-MIBI ECT myocardiography is higher than that of maximal plate exercise ECG or 24-hour ambulatory ECG in the early diagnosis of the ischemia heart disease in aged NIDDM patients.