糖尿病患者无症状心肌缺血检测（DIAD）研究中高危受试者5年结局的回顾性分析

2. Five-Year Outcomes in High-Risk Participants in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Study

A post hoc analysis

糖尿病患者无症状心肌缺血检测（DIAD）研究中高危受试者5年结局的回顾性分析海南医学院附属医院内分泌科王新军

Abstract

OBJECTIVE To estimate baseline cardiovascular risk of 1,123 participants in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study and to assess cardiac event rates and the effect of screening on outcomes in these higher-risk participants.

目的  估计糖尿病患者无症状心肌缺血检测（DIAD）研究中1123例受试者基线心血管危险，并评估心血管事件发生率及筛查对这些高高危受试者结局的影响。

RESEARCH DESIGN AND METHODS Baseline cardiovascular risk was assessed using four established methods: Framingham score, UK Prospective Diabetes Study (UKPDS) risk engine, criteria of the French-Speaking Association for the Study of Diabetes and Metabolic Diseases, and the presence or absence of metabolic syndrome. Cardiac events (cardiac death or nonfatal myocardial infarction) were assessed during the 4.8-year follow-up in participants with intermediate/high cardiovascular risk.

研究设计与方法  基线心血管风险采用四种方法评估：Framingham评分，英国前瞻性糖尿病研究（UKPDS）的风险评估，法语糖尿病和代谢性疾病研究会的标准，以及是否存在代谢综合征。在随访4.8年对随访者进行心血管事件（心源性死亡或非致死性心肌梗死）进行评估。

 

 

 

 

 

 

 

 

 

朗读

Yánjiū shèjì yǔ fāngfǎ jīxiàn xīn xiěguǎn fēngxiǎn pínggū cǎiyòng sì jiànlì de fāngfǎ:Framingham de píngfēn, yīngguó qiánzhān xìng tángniàobìng yánjiū (UKPDS) de fēngxiǎn yǐnqíng, fǎyǔ xiéhuì de biāozhǔn wèi tángniàobìng hé dàixiè xìng jíbìng de yánjiū, yǐjí shìfǒu cúnzài huò quēfá dàixiè Zònghé zhēng. Xīnzàng shìjiàn (xīn yuán xìng sǐwáng huò fēi zhìsǐ xing xīnjī gěngsǐ) jìnxíng le pínggū, zài 48 nián de gēnzōng yǔ zhōngjí/gāo xīn xiěguǎn fēngxiǎn de cānjiā zhě.

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RESULTS By various risk-stratification approaches, 53?75% of participants were defined as having intermediate or high cardiovascular risk. The prevalence of inducible ischemia on screening in these individuals ranged from 21 to 24%, similar to lower-risk participants (19?23%). Cardiac event rates were greater in intermediate-/high-risk versus low-risk groups, but this was only significant for the UKPDS risk engine (4.2 vs. 1.2%, P = 0.002). The annual cardiac event rate was <1% in all risk groups, except in the high-risk UKPDS group (～2% per year). In intermediate-/high-risk participants randomized to screening versus no screening, 4.8-year cardiac event rates were similar (2.5?4.8% vs. 3.1?3.7%).

结果  通过各种危险分层方法，53~75％的受试者被定义为具有中危或高危心血管风险。在这些个体中诱导缺血的发生率为21~24％，与低危受试者（19~23％）相似。与低危组相比，中危和高危组受试者心血管事件发生率较高，但仅在UKPDS风险评分时差异有显著性（4.2 vs1.2％，P =0.002）。除在高风险UKPDS组（每年约2％）以外，在所有风险组，每年心血管事件发生率<1％。中危和高危组受试者随机分为筛查和不筛查，4.8年心血管事件发生率相似（2.5~4.8 vs 3.1~3.7％％）。

CONCLUSIONS A substantial portion of the DIAD population was defined as having intermediate/high baseline cardiovascular risk. Nevertheless, their annual cardiac event rate was low and not altered by routine screening for inducible ischemia.

结论  糖尿病患者无症状心肌缺血检测（DIAD）的受试者很大一部分被界定为具有中危/高危心血管风险。然而，他们的每年心血管事件发生率较低，而且常规进行诱导缺血筛查并不改变其心血管事件发生率。

Diabetes Care January 2011 34:204-209