糖尿病人無症狀冠心病的篩檢

Screening for Asymptomatic Coronary Heart Disease in Diabetic Patients

陳朝欽(Chao-Chin Chen) ； 雷孟桓(Meng-Huan Lei)

《內科學誌》 19卷3期 (2008/06) Pp. 227-237

https://doi.org/10.6314/JIMT.2008.19(3).06

摘要

糖尿病是心血管疾病的重要危險因子，而且冠狀動脈心臟病（冠心病）是第二型糖尿病患病率與死亡率的首要原因。糖尿病合併冠心病的難題在其臨床上時常沒有症狀，等到發病時已進展到嚴重的階段。目前可知的數據顯示有相當多的糖尿病人已有冠心病未被診斷出來，而值得去篩檢。爲了能負擔此篩檢，首先就須確認病人究竟應合併一項、二項或其他重要的危險因子，才是屬於高風險而值得去篩檢的對象。其次多項研究已確立以心肌灌流閃爍照影偵測無痛性心肌缺血，或以冠狀動脈鈣化指數測量亞臨床性動脈硬化的角色，可作爲冠心病短期預後與危險分級的參考，同時建議階段性篩檢（即先測量冠狀動脈鈣化指數有必要再作心肌灌流閃爍照影）應該是更理想的方式且符合成本效益。最後仍需探討此篩檢程序是否有助於改變病人治療策略，進而改善病人預後。這些課題有賴於進一步的研究，包括成本效益分析。

關鍵字

冠心病 ； 糖尿病 ； 無症狀心肌缺血 ； 亞臨床性動脈粥狀硬化

並列摘要

Diabetes mellitus (DM) is an important risk factor for cardiovascular disease. Moreover, coronary artery disease (CAD) are the leading causes for morbidity and mortality in patients with type 2 DM. The conundrum of CAD in conjunction with type 2 diabetes is that it is often silent and when it becomes clinically manifest the disease is often in an advanced stage. The currently available data do suggest a significant prevalence of undiagnosed CAD in this population, which may warrant screening. To make this screening more affordable, high risk diabetic patients with 1, or ≧ 2 additional coronary risk factors should be defined first and foremost. Several reports have shown that detection of coronary atherosclerosis by imaging of coronary calcification using cardiac computed tomography(CT) or silent ischemia by stress myocardial perfusion scintigraphy (MPS) may predicted short-term outcome and improve risk stratification. A stepwise screening, with assessment of atherosclerosis by cardiac CT, followed by MPS if needed, maybe an optimal modality and cost-effective. Finally, the screening algorithm should result in the alteration of individual treatment strategies and lead to improved outcome. Accordingly, further studies are needed to address this issue and should include cost-effective analyses.

並列關鍵字

Coronary heart disease ； Diabetes ； Silent ischemia ； Subclinical atherosclerosis