【医学生物PPT】内分泌疾病研究进展郝立智医师.ppt

业精于勤荒于嬉 行成于思毁于随 →【医学生物PPT，欢迎收藏分享】豆丁网友 Update in Endocrinology 郝 立 智 醫 師 永康榮民醫院新陳代謝科 95-05-05 Annals of internal Medicine: 1 Nov. 2005 | Vol. 143 Issue 9 | P. 673-682 Outline DM Thyroid Disease Lipid-Lowering Therapy Adrenal Function Myocardial Perfusion Imaging Should Be Considered To Detect Silent CAD in Diabetic pts (DM Care. 2004;27:1954-61.) ADA guidelines recommend routine exercise ECG stress testing to detect silent CAD in diabetic pts when 2 or more additional risk factors are present. The Detection of Ischemia in Asymptomatic Diabetics (DIAD) study tested the effectiveness of these guidelines. Pts with type 2 DM ranging in age from 50 to 75 years (n = 1123) with no known CAD were randomly assigned to 2 groups: One group (n = 522) underwent standard exercise ECG stress testing followed by ECG-gated regional myocardial perfusion imaging by single-photon emission computed tomography (SPECT) at rest and after exercise, whereas the second group (n = 522) did not undergo testing. Both groups were reevaluated 5 years later. The results indicated that 22% of the pts who underwent testing (n = 113) were found to have evidence of silent coronary disease on the basis of moderate to large perfusion defects (n = 33), ventricular dilatation, ventricular dysfunction at rest, or adenosine-induced ST-segment depression. The strongest predictors for coronary disease were male sex (odds ratio, 2.5 [P 0.03]), duration of DM (odds ratio, 5.2 [P 0.002]), and abnormal response to the Valsalva maneuver (odds ratio, 5.6 [P 0.001]). The researchers reported that 60% of the pt sample (n = 306) had 2 or more risk factors, which made them eligible for screening by ADA guidelines, whereas 204 pts had fewer than 2 risk factors. Of these 204 pts, 45 had abnormal test results. Thus, CAD would not have been detected in these pts if their physicians used only the ADA guidelines to screen for eligibility for testing. The authors concluded that, on the basis of results of