冠状动脉心脏病伴有糖尿病患者的心绞痛特点分析

目的 提高对冠状动脉心脏病(冠心病)合并糖尿病患者的心绞痛特点的认识.方法 回顾性分析1996年1月1日至2007年1月1日行冠状动脉造影的患者4873例,分为糖尿病组和非糖尿病组,记录胸痛发作的症状.以冠状动脉造影为金标准,将胸痛症状与冠状动脉造影结果比较,分析胸痛症状对诊断冠状动脉狭窄的敏感性、特异性、阳性预测值和阴性预测值.结果 4873例研究对象中,冠状动脉明显狭窄的糖尿病患者1431例,表现为胸痛1组症状(非心源性胸痛)187例、2组症状(不典型心绞痛)492例及3组症状(典型心绞痛)752例.冠状动脉明显狭窄非糖尿病者2056例,表现为非心源性胸痛、不典型心绞痛和典型心绞痛的患者分别为297例、735例和1024例.糖尿病和非糖尿病组之间比较,无论是非心源性胸痛、不典型心绞痛和典型心绞痛,对于冠状动脉明显狭窄的诊断,阳性预测值和阴性预测值差异均有统计学意义,敏感性和特异性差异无统计学意义.临床症状对于冠心病诊断的准确性,胸痛3组症状优于2组症状,2组症状优于1组症状.在非糖尿病组,冠状动脉狭窄的支数与心绞痛的表现类型密切相关(P＜0.01),而在糖尿病组,冠状动脉狭窄的支数与心绞痛的表现类型相关不明显(P=0.333).结论 典型心绞痛对于冠心病诊断的准确性较高.在非糖尿病患者中,胸痛特点能反映冠状动脉病变严重程度.

Characteristics of angina in patients with coronary artery disease complicated by diabetes mellitus

OBJECTIVE: To improve the understanding of chest pain and angina pectoris in patients with diabetes mellitus (DM). METHODS: The clinical features and angina characteristics of 4873 patients undergoing coronary angiography (CAG) were recorded. The characteristics of angina pectoris of 1431 patients with coronary artery diseases (CAD) complicated by DM were analyzed. For detecting coronary artery disease, the sensitivity, specificity, positive predictive value, and negative predictive value were analyzed according to chest pain and coronary angiography. RESULTS: Of the 1431 CAD patients with DM 187 only presented non-cardiac chest pain, 492 presented atypical angina, and 752 presented typical angina. Of the CAD 2056 patients without DM 297 only presented non-cardiac chest pain, 735 presented atypical angina, and 1024 presented typical angina. In detecting coronary artery disease, no matter with what type of chest pain, the positive predictive values of the DM group were all remarkably higher than those of the non-DM group, and the negative predictive values of the DM group were all remarkably lower than those of the non-DM group, however, there were not significant differences in the sensitivity and specificity between the DM group and non-DM group. In the non-DM group the number of stenotic branches of coronary artery was closely associated with the angina characteristics (P < 0.01), however, in the DM group the number of stenotic branches of coronary artery was not associated with the angina characteristics (P = 0.333). CONCLUSION: Typical angina pectoris is a clinical manifestation with high accuracy in diagnosis of CAD. In the non-DM patients, the characteristics of chest pain reflect the severity of coronary artery stenosis.