Asymptomatic Coronary Artery Disease: Angiographic Assessment of Diabetics Evaluated for Renal Transplantation
Asymptomatic Coronary Artery Disease: Angiographic Assessment of Diabetics Evaluated for Renal Transplantation
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无症状冠状动脉疾病：接受肾移植评估的糖尿病患者的血管造影评估
作者：
L. Weinrauch;J. D'Elia;R. W. Healy;R. Gleason;A. Christlieb;Stevens Leland
总结21例伴氮质血症肾病的胰岛素依赖型糖尿病患者通过选择性冠状动脉造影和电影左心室造影评估肾移植的可行性。所有患者均患有高血压、视网膜病变、神经病变，需要限制盐摄入并使用利尿剂治疗容量超负荷。二十名患者没有缺血性冠状动脉疾病的临床或心电图证据。十名患者（5名男性，5名女性，平均年龄29.3岁;平均糖尿病持续时间18.9年;平均血清胆固醇264 mg%）无明显冠状动脉疾病，也无室壁运动异常。（7名男性，2名女性;平均年龄38.7岁;平均糖尿病持续时间21.9年;平均血清胆固醇239 mg%）有明显的冠状动脉疾病，7名显示左心室壁运动局灶性异常。（1男1女;平均年龄36.5岁;平均糖尿病病程28.5年;平均血清胆固醇250 mg%）无明显冠状动脉疾病，但表现为弥漫性左室壁运动异常伴射血分数降低，38%有心电图临床数据无法预测的严重冠状动脉疾病。52%的糖尿病严重肾高血压并发症患者没有明显的冠状动脉疾病，这一发现令人惊讶。两名患者可能有心肌病。
SUMMARY Twenty-one insulin-dependent diabetics with azotemic nephropathy were evaluated for renal transplantation by selective coronary angiography and cine left ventriculography. All had hypertension, retinopathy, neuropathy, and required salt restriction plus diuretics for volume overload. There was no clinical or electrocardiographic evidence of ischemic coronary artery disease in twenty.Ten patients (five males, five females, mean age 29.3 years; mean duration of diabetes 18.9 years; mean serum cholesterol 264 mg%) had no significant coronary artery disease and no ventricular wall motion abnormalities.Nine patients (seven males, two females; mean age 38.7 years; mean duration of diabetes 21.9 years; mean serum cholesterol 239 mg%) had significant coronary artery disease, seven demonstrating focal abnormalities in left ventricular wall motion.Two patients (one male, one female; mean age 36.5 years; mean duration of diabetes 28.5 years; mean serum cholesterol 250 mg%) had no significant coronary artery disease, but demonstrated diffusely abnormal left ventricular wall motion with diminished ejection fraction.Thirty-eight percent had significant coronary artery disease unpredictable by electrocardiographic clinical data. The finding of no significant coronary artery disease in 52% of a group with severe renalhypertensive complications of diabetes is surprising. Two patients may have a demonstrated cardiomyopathy.