Cardiovasc Diabetol:1型糖尿病患者的动脉僵硬度及其与心血管风险评估工具的比较

2022-06-21 从医路漫漫 MedSci原创

根据最新的欧洲心脏病学会(ESC)关于糖尿病、糖尿病前期和CVD的指南,T1D持续时间较长(即> 10年)的患者被自动视为具有发生CVD的高风险或非常高的风险。

背景:尽管在过去十年中,患者护理有了实质性改善,心血管疾病(CVD)发病率和死亡率显著降低,但1型糖尿病(T1D)患者的心血管负担仍然增加。根据最新的欧洲心脏病学会(ESC)关于糖尿病、糖尿病前期和CVD的指南,T1D持续时间较长(即> 10年)的患者被自动视为具有发生CVD的高风险或非常高的风险。然而,T1D心血管风险似乎存在实质性的异质性。因此,准确评估T1D患者的心血管风险至关重要,对心血管风险分层工具的研究兴趣越来越大。

尽管对传统的心血管危险因素进行了充分的控制,但一些T1D患者还是发生了心血管疾病,反之亦然,这一事实表明,这些因素本身并不能完全反映心血管疾病的总风险。由于目前仍不推荐在无症状T1D患者中进行常规CVD筛查,因此需要针对心血管风险的替代生物标志物,其中动脉僵硬度尤其令人感兴趣。动脉僵硬度被认为是动脉壁上所有心血管风险标记物的“综合指标”,即还考虑了导致心血管风险增加的其他有害过程,如低度炎症或氧化应激。与独立于传统心血管危险因素的健康年龄匹配对照组相比,T1D患者的动脉僵硬度增加。更重要的是,颈动脉-股动脉脉搏波速度(cf-PWV)是衡量动脉僵硬度的金标准,在健康人群和患病人群的CVD发展和死亡率方面显示出重要的独立预后价值。在T1D患者中,主动脉PWV与小血管和大血管疾病的存在相关[26],最近的一项前瞻性研究表明cf-PWV对心血管事件和死亡率具有预测作用。

然而,在T1D无症状患者中,cf-PWV如何与其他心血管风险评估方法相比较仍是个问题。一种T1D特异性心血管风险评估工具是STENO engine,这是一种经过验证的预测模型,旨在评估既往无心血管疾病史的T1D患者发生心血管事件的10年风险。另一方面,T1D中的心血管风险分类也可以基于ESC指南。

目的:目前的研究旨在评估通过cf-PWV评估T1D持续时间至少为10年且仍无已知心血管疾病的患者的动脉僵硬度,并将cf-PWV与其他用于T1D的心血管风险评估工具进行比较。

方法:对T1D持续时间至少10年且未确诊CVD的成人进行横断面研究。根据2019年欧洲心脏病学会(ESC)指南,将患者分为心血管疾病风险组,并使用STENO T1D风险引擎来估计心血管事件的10年风险。动脉僵硬度用颈动脉-股动脉脉搏波速度(cf-PWV)评估。评估冠状动脉钙(CAC)评分并进行颈动脉超声检查。评估24小时动态血压和中心血液动力学参数。检索肾功能和糖尿病肾病的数据。

结果:54例患者(年龄:46±9.5岁;T1D持续时间:27±8.8年)。基于cf-PWV,四分之一的患者显示主动脉僵硬度过早增加(24%)。Cf-PWV与CAC评分、颈动脉内膜中层厚度、中枢血液动力学参数和糖尿病肾病显著相关。根据STENO,20名患者(37%)10年心血管事件风险较低,20名患者(37%)风险中等,14名患者(26%)风险较高。Cf-PWV与STENO评分密切相关(RS =+0.81;R2 = 0.566,p < 0.001),随着每个更高的狭窄组而增加(p < 0.01)。然而,根据ESC标准,cf-PWV在两个心血管风险组(高与非常高)之间没有显著差异,ESC标准与STENO相比,将10名患者分类为心血管事件10年风险> 10%(n = 44/54;81.5%对n = 34/54;63%).

图1颈动脉-股动脉脉搏波速度分布(cf-PWV;m/s)

表1心血管成像结果和功能结果

图2用颈动脉-股动脉脉搏波速度(cf-PWV)预测STENO T1D CV事件风险评分的单变量线性回归

图3基于ESC标准(红色)与STENO(蓝色)的10年心血管事件风险> 10%的患者

结论:这项研究表明,很大一部分长期T1D无已知心血管疾病的患者表现出过早的动脉硬化。Cf-PWV与未来心血管事件的狭窄风险评分以及心血管成像和功能结果密切相关,从而说明了动脉硬化的临床重要性。然而,这些数据也显示了心血管风险的相当大的异质性,以及STENO工具和ESC标准之间风险分类的差异。T1D患者心血管风险分类需要进一步完善,未来的研究应调查是否应在T1D临床实践中评估动脉僵硬度,以及哪些患者从评估中获益最大。

原文出处: Helleputte S,  Van Bortel L,  Verbeke F, et al.Arterial stiffness in patients with type 1 diabetes and its comparison to cardiovascular risk evaluation tools.Cardiovasc Diabetol 2022 Jun 09;21(1) 

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  4. 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  5. 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    2023-05-08 quxin068
  6. 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  7. 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channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89812, encryptionId=56658981223, topicName=血管风险)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/78FA0899509C358B01B975E8EAC1F88A/100, createdBy=7d822500145, createdName=ms5353107019656438, createdTime=Sat Apr 15 15:45:10 CST 2023, time=2023-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1227732, encodeId=1bec122e73275, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Tue Jun 21 11:44:12 CST 2022, time=2022-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1227731, encodeId=bfb9122e73196, content=认真学习~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Tue Jun 21 11:43:23 CST 2022, time=2022-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475295, encodeId=81ab14e52957f, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Jun 18 02:45:10 CST 2022, time=2022-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546773, encodeId=fd2a1546e7326, content=<a href='/topic/show?id=de1233215db' target=_blank style='color:#2F92EE;'>#动脉僵硬#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33215, encryptionId=de1233215db, topicName=动脉僵硬)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b48f13938152, createdName=dlwang_26703131, createdTime=Sat Jun 18 02:45:10 CST 2022, time=2022-06-18, status=1, ipAttribution=)]
    2022-06-21 1209e435m98(暂无昵称)

    学习了,谢谢分享

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1761956, encodeId=7d851e61956d5, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Tue Sep 13 14:45:10 CST 2022, time=2022-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2046752, encodeId=0e142046e52ce, content=<a href='/topic/show?id=fd539148067' target=_blank style='color:#2F92EE;'>#评估工具#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91480, encryptionId=fd539148067, topicName=评估工具)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8fc0211, 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encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Sat Jan 14 06:45:10 CST 2023, time=2023-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1939447, encodeId=046b193944e5c, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Mon May 08 05:45:10 CST 2023, time=2023-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2082595, encodeId=82bf2082595af, content=<a href='/topic/show?id=56658981223' target=_blank style='color:#2F92EE;'>#血管风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89812, encryptionId=56658981223, topicName=血管风险)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/78FA0899509C358B01B975E8EAC1F88A/100, createdBy=7d822500145, createdName=ms5353107019656438, createdTime=Sat Apr 15 15:45:10 CST 2023, time=2023-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1227732, encodeId=1bec122e73275, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Tue Jun 21 11:44:12 CST 2022, time=2022-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1227731, encodeId=bfb9122e73196, content=认真学习~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Tue Jun 21 11:43:23 CST 2022, time=2022-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475295, encodeId=81ab14e52957f, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Jun 18 02:45:10 CST 2022, time=2022-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546773, encodeId=fd2a1546e7326, content=<a href='/topic/show?id=de1233215db' target=_blank style='color:#2F92EE;'>#动脉僵硬#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33215, encryptionId=de1233215db, topicName=动脉僵硬)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b48f13938152, createdName=dlwang_26703131, createdTime=Sat Jun 18 02:45:10 CST 2022, time=2022-06-18, status=1, ipAttribution=)]
    2022-06-21 xulv123

    认真学习~~

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1761956, encodeId=7d851e61956d5, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Tue Sep 13 14:45:10 CST 2022, time=2022-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2046752, encodeId=0e142046e52ce, content=<a href='/topic/show?id=fd539148067' target=_blank style='color:#2F92EE;'>#评估工具#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91480, encryptionId=fd539148067, topicName=评估工具)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8fc0211, 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encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Sat Jan 14 06:45:10 CST 2023, time=2023-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1939447, encodeId=046b193944e5c, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Mon May 08 05:45:10 CST 2023, time=2023-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2082595, encodeId=82bf2082595af, content=<a href='/topic/show?id=56658981223' target=_blank style='color:#2F92EE;'>#血管风险#</a>, beContent=null, objectType=article, 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channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Tue Jun 21 11:43:23 CST 2022, time=2022-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475295, encodeId=81ab14e52957f, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Jun 18 02:45:10 CST 2022, time=2022-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546773, encodeId=fd2a1546e7326, content=<a href='/topic/show?id=de1233215db' target=_blank 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  10. 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