摘要
2型糖尿病(DM)与心血管风险增加有关,部分原因是其加速了亚临床动脉粥样硬化的发展临床上,心电图(ECG)和踝臂指数(ABI)异常被用于心血管风险的筛查但是,尚不清楚这二者识别伴有非阻塞性亚临床动脉粥样硬化的2型DM患者的能力冠状动脉钙化(CAC)是冠状动脉粥样硬化的指标采用多变量有序回归模型,测定了589例无症状2型DM患者中ECG和ABI异常与CAC的相关性,并测定了该检测方法的灵敏性、
Type 2 diabetes mellitus(DM) is associated with increased cardiovascular risk, in part due to accelerated subclinical atherosclerosis. Electrocardiographic(ECG) and ankle-brachial index(ABI) abnormalities are used to screen for cardiovascular risk in the clinic. However, their capacity to identify patients with type 2 DM with nonobstructive subclinical atherosclerosis is unknown. Associations of ECG and ABI abnormalities with coronary artery calcium(CAC), a measure of coronary atherosclerosis, were examined using multivariable ordinal regression modeling in 589 asymptomatic patients with type 2 DM. Sensitivity, specificity, and positive and negative predictive values were determined. CAC was prevalent(44% CAC >100; 32% CAC >75th percentile score) despite normal electrocardiograms(64% ) and ABIs(97% ) in most subjects. Neither ECG nor ABI changes predicted CAC after adjusting for age, gender, and race. ECG abnormalities were neither sensitive nor specific for detection of CAC >100, >400, or >75th percentile(sensitivities 0.43, 0.45, and 0.34; specificities 0.69, 0.66, and 0.63, respectively). ABI abnormalities were not sensitive(0.03, 0.04, and 0.03) but had high specificity(0.98, 0.98, and 0.98). In subjects with normal electrocardiograms and ABIs,extensive CAC was remarkably prevalent(CAC >100 in 24% ). In conclusion, ECG and ABI abnormalities failed to detect patients with subclinical coronary atherosclerosis and therefore may be of limited value in identifying many asymptomatic patients with type 2 DM at increased risk of cardiovascular disease.
