2型糖尿病合并无症状冠心病的危险因素——研究现状分析

钱 盈希, 陆泽 元*
中山大学附属第八医院内分泌科

摘要


目前2型糖尿病（Type 2 Diabetes Mellitus，T2DM）及其并发症患病率及死亡率逐年升高，其中无症状冠
心病（Asymptomatic Coronary Heart Disease，ACHD）因其隐匿性强而容易被忽视，严重威胁患者健康。本文针对
T2DM合并ACHD的常见危险因素及其可能的机制做一综述，对临床早期识别并诊治疾病、构建预测模型具有重要
意义。

关键词


2型糖尿病；无症状冠心病；危险因素；机制

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参考


[1]American Diabetes Association. Classification and

diagnosis of diabetes: standards of medical care in diabetes-

2020[J]. Diabetes Care, 2020, 43: S14-S31.

[2]Oluyombo R, Olamoyegun MA, Olaifa O, Iwuala

SO, Babatunde OA. Cardiovascular risk factors in semi-urban

communities in southwest Nigeria: patterns and prevalence[J].

J Epidemiol Glob Health, 2015, 5: 167-174.

[3]NCD Risk Factor Collaboration (NCD-RisC).

Worldwide trends in diabetes prevalence and treatment

from 1990 to 2022: a pooled analysis of 1108 populationrepresentative studies with 141 million participants[J]. Lancet,

2024, 404(10467): 2077-2093.

[4]高明妃，胡如英，胡崇高.中国糖尿病死亡流行

特征研究进展[J].预防医学，2022，34（7）：692-695.

[5]杨宗璐，柯亭羽.糖尿病并发心血管疾病的研究

进展[J].中国老年保健医学，2021，19（1）：92-94+98.

[6]Mosenzon O, Alguwaihes A, Leon JLA, et al.

CAPTURE: a multinational, cross-sectional study of

cardiovascular disease prevalence in adults with type 2 diabetes

across 13 countries[J]. Cardiovasc Diabetol, 2021, 20(1): 154.

[7]Vigili de Kreutzenberg S, Solini A, Vitolo E, et al.

Silent coronary heart disease in patients with type 2 diabetes:

application of a screening approach in a follow-up study[J]. J

Diabetes Complications, 2017, 31(6): 952-957.

[8]Natali A, Vichi S, Landi P, et al. Coronary

atherosclerosis in type II diabetes: angiographic findings and

clinical outcome[J]. Diabetologia, 2000, 43: 632-641.

[9]Tsujimoto T, Kajio H, Takahashi Y, et al.

Asymptomatic coronary heart disease in patients with type

2 diabetes with vascular complications: a cross-sectional

study[J]. BMJ Open, 2011, 2: e000139.

[10]Davis TME, Coleman RL, Holman RR. Prognostic

significance of silent myocardial infarction in newly diagnosed

type 2 diabetes mellitus[J]. Circulation, 2013, 127: 980-987.

[11]Wong ND, Sattar N. Cardiovascular risk in diabetes

mellitus: epidemiology, assessment and prevention[J]. Nat

Rev Cardiol, 2023, 20: 685-695.

[12]Wright AK, Suarez-Ortegon MF, Read SH, et al.

Risk factor control and cardiovascular event risk in people

with type 2 diabetes in primary and secondary prevention

settings[J]. Circulation, 2020, 142(20): 1925-1936.

[13]Cosentino F, et al. ESC guidelines on diabetes, prediabetes, and cardiovascular diseases developed in collaboration

with the EASD[J]. Eur Heart J, 2020, 41: 255-323.

[14]Kones R. Molecular sources of residual

cardiovascular risk, clinical signals, and innovative solutions:

relationship with subclinical disease, undertreatment, and poor

adherence: implications of new evidence upon optimizing

cardiovascular patient outcomes[J]. Vasc Health Risk Manag,

2013, 9: 617 - 670.

[15]Guasch - Ferré M, Santos J L, Martínez -

González M A, et al.Glycolysis/gluconeogenesis - and

tricarboxylic acid cycle - related metabolites, Mediterranean

diet, and type 2 diabetes[J]. American Journal of Clinical

Nutrition, 2020, 111(4): 835 - 844.

[16]Choi CS, Kim YB, Lee FN, Zabolotny JM, Kahn

BB, Youn JH. Lactate induces insulin resistance in skeletal

muscle by suppressing glycolysis and impairing insulin

signaling[J]. Am J Physiol Endocrinol Metab, 2002, 283:

E233-40.

[17]Ahmed K, Tunaru S, Tang C, Müller M, Gille A,

Sassmann A, Hanson J, Offermanns S. An autocrine lactate

loop mediates insulin-dependent inhibition of lipolysis

through GPR81[J]. Cell Metab, 2010, 11: 311-19.

[18]Bangalore S, Breazna A, DeMicco DA, Wun

CC, Messerli FH. Visit-to-visit low-density lipoprotein

cholesterol variability and risk of cardiovascular outcomes:

insights from the TNT trial[J]. J Am Coll Cardiol, 2015, 65:

1539-1548.

[19]Stevens RJ, Kothari V, Adler AI, Stratton IM. The

UKPDS risk engine: A model for the risk of coronary heart

disease in type II diabetes (UKPDS 56)[J]. Clinical Science

(London), 2001, 101: 671-679.[20]Katakami N. Mechanism of development of

atherosclerosis and cardiovascular disease in diabetes

mellitus[J]. J. Atheroscler. Thromb., 2018, 25: 27-39.

[21]Wang YB, Yu QJ, Fan DM, et al. Coronary heart

disease in Type 2 diabetes: mechanisms and comprehensive

prevention strategies[J]. Expert Rev Cardiovasc Ther, 2012,

10(8): 1051 - 1060.

[22]Chen J, Zhang Y, Liu J, Chen MH, Guo YL,

Zhu CG, Xu RX, Dong Q, Li JJ. Role of lipoprotein(a) in

predicting the severity of new on-set coronary artery disease

in type 2 diabetics: A Gensini score evaluation[J]. Diabetes

Vasc Dis Res, 2015, 12: 258-264.

[23]Gouni-Berthold I, Berthold HK. Lipoprotein(a):

current perspectives[J]. Curr Vasc Pharmacol, 2011, 9: 682-692.

[24]Wolsk AA, Reimuind M, Sviridov DO, et al.

Apolipoprotein Mimetic Peptides: Potential New Therapies

for Cardiovascular Diseases[J]. Cells, 2021, 10: 597.

[25]苏广胜，付茜，庞文跃.载脂蛋白B/载脂蛋白

A1比值与青年冠心病患者冠状动脉病变严重程度的研究

[J].临床心血管病杂志，2021，37（7）：663-667.

[26]Kanbay M, Solak Y, Unal HU, Kurt YG, Gok M,

Cetinkaya H, et al. Monocyte Count/HDL Cholesterol Ratio

and Cardiovascular Events in Patients with Chronic Kidney

Disease[J]. International Urology and Nephrology, 2014, 46:

1619-1625.

[27]Cetin MS, Ozcan Cetin EH, Kalender E, Aydin

S, Topaloglu S, Kisacik HL, et al. Monocyte to HDL

Cholesterol Ratio Predicts Coronary Artery Disease Severity

and Future Major Cardiovascular Adverse Events in Acute

Coronary Syndrome[J]. Heart, Lung and Circulation, 2016,

25: 1077-1086.

[28]Stratton IM, Adler AI, Neil HA, Matthews DR,

Manley SE, Cull CA, Hadden D, Turner RC, Holman

RR. Association of glycaemia with macrovascular and

microvascular complications of type 2 diabetes (UKPDS

35): prospective observational study. BMJ. 2000 Aug

12;321(7258):405-12.

[29]Hong LF, Li XL, Guo YL, Luo SH, Zhu CG, Qing

P, et al. Glycosylated hemoglobin A1c as a marker predicting

the severity of coronary artery disease and early outcome in

patients with stable angina[J]. Lipids Health Dis, 2014, 13: 89.

[30]Albashir AAD, Elawad O, Khougali MH. The

use of glycosylated hemoglobin (HbA1c) as a predictor of

the severity of acute coronary syndrome among diabetic

patients[J]. Ir J Med Sci, 2021, 190(2): 609-614.

[31]Jiao X, Zhang Q, Peng P, Shen Y. HbA1c is a

predictive factor of severe coronary stenosis and major adverse

cardiovascular events in patients with both type 2 diabetes and

coronary heart disease[J]. Diabetol Metab Syndr, 2023, 15(1): 50.

[32]Ostergaard HB, Mandrup-Poulsen T, Berkelmans

GFN, et al. Limited benefit of haemoglobin glycation index

as risk factor for cardiovascular disease in type 2 diabetes

patients[J]. Diabetes Metab, 2019, 45(3): 254 - 260.

[33]Turner RC, Holman RR. The UK Prospective

Diabetes Study. UK Prospective Diabetes Study Group[J].

Annals of Medicine, 1996, 439-444.

[34]Reboldi G, et al. Glomerular hyperfiltration is a

predictor of adverse cardiovascular outcomes[J]. Kidney Int.,

2018, 93: 195-203.

[35]Jankowski J, Floege J, Fliser D, Böhm M, Marx

N. Cardiovascular disease in chronic kidney disease:

pathophysiological insights and therapeutic options[J].

Circulation, 2021, 143(11): 1157-72.

[36]Govardi E, Yulianda D, Habib F, Pakpahan C.

Microalbuminuria and mortality in individuals with coronary

heart disease: A meta-analysis of a prospective study[J]. Indian

Heart J, 2023, 75(4): 229-235.

[37]许丽娃，崔晓红.2型糖尿病患者微量白蛋白尿与

冠心病的关系[J].中国热带医学，2007，7（5）：747-754.

[38]Handelsman Y, Anderson JE, Bakris GL, et al.

DCRM Multispecialty Practice Recommendations for the

management of diabetes, cardiorenal, and metabolic diseases[J].

J Diabetes Complications, 2022, 36(2): 108101.

[39]王铎霖，刘乙君，李萍，等.估算的肾小球滤过

率轻度下降与白蛋白尿对2型糖尿病患者心血管疾病风

险的交互作用研究[J].中华糖尿病杂志，2024，16（7）：

746-754.

[40]Polak JF, Szklo M, O'Leary DH. Associations of

coronary heart disease with common carotid artery near and

far wall intima‐media thickness: the multi‐ethnic study of

atherosclerosis[J]. J Am Soc Echo, 2015, 28: 1114-1121.

[41]JIA Ming-li, ZENG Bin. Diagnostic value of carotidintima-media thickness for coronary heart disease in patients

with type 2 diabetes mellitus[J]. Clinical Focus, 2014, 29(9):

982-984985.

[42]Brohall G, Oden A, Fagerberg B. Carotid artery

intima-media thickness in patients with type 2 diabetes

mellitus and impaired glucose tolerance: a systematic review[J].

Diabet Med, 2006, 23: 609.

[43]曾玲，陆泽元，蒋凤秀，等.2型糖尿病患者颈

动脉斑块积分与无症状冠心病关系的研究[J].中国糖尿病

杂志，2021，29（3）：173-177.

[44]曾玲，陆泽元，伍贵富，等.2型糖尿病患者下

肢动脉病变预测无症状冠心病的临床价值研究[J].中国糖

尿病杂志，2018，26（11）：890-894.

[45]Alves-Cabratosa L, et al. Levels of ankle-brachial

index and the risk of diabetes mellitus complications[J]. BMJ

Open Diabetes Res Care, 2020, 8: e000977.

[46]Forés R, Alzamora MT, Pera G, et al. Contribution

of the Ankle-brachial index to improve the prediction of

coronary risk: the ARTPER cohort[J]. PLoS One, 2018, 13:

1-12.

[47]Volpe M, Gallo G. Hypertension, coronary artery

disease and myocardial ischemic syndromes[J]. Vascul

Pharmacol, 2023, 153: 107230.

[48]Pagliaro BR, Cannata F, Stefanini GG, et al.

Myocardial ischemia and coronary disease in heart failure[J].

Heart Fail Rev, 2020, 25: 53-65.

[49]Wang HH, Lee DK, Liu M, et al. Novel insights

into the pathogenesis and management of the metabolic

syndrome[J]. Pediatr Gastroenterol Hepatol Nutr, 2020, 23:

189-230.

[50]Kozakova M, Morizzo C, Fraser AG, et al. Impact of

glycemic control on aortic stiffness, left ventricular mass and

diastolic function in type 2 diabetes mellitus[J]. Cardiovasc

Diabetol, 2017, 16: 78. DOI: 10.1186/s12933-017-0557-z.

[51]Tatsumi Y, Ohkubo T. Hypertension with diabetes

mellitus: significance from an epidemiological perspective for

Japanese[J]. Hypertens Res, 2017, 40: 795-806.

[52]中国医疗保健国际交流促进会心血管病学分

会.高血压合并冠心病患者血压管理中国专家共识[J].中

华医学杂志，2022，102（10）：717-728.

[53]Choi YJ, Kim SH, Kang SH, et al. Reconsidering

the cut-off diastolic blood pressure for predicting

cardiovascular events: a nationwide population-based study

from Korea[J]. Eur Heart J, 2019, 40(9): 724-731.

[54]李翔，严同，许樟荣.糖尿病和高血压[J].中华

糖尿病杂志，2021，13（7）：740-745.

[55]Muntner P, Whittle J, Lynch AI, et al. Visit-to-visit

variability of blood pressure and coronary heart disease, stroke,

heart failure, and mortality: a cohort study[J]. Ann Intern

Med, 2015, 163: 329-338.

[56]Rzehak P, Meisinger C, Woelke G, et al. Weight

change, weight cycling and mortality in the ERFORT Male

Cohort Study[J]. Eur J Epidemiol, 2007, 22: 665-673.

[57]Oumer A, Ale A, Tariku Z, et al. Waist-to-hip

circumference and waist-to-height ratio could strongly

predict glycemic control than body mass index among adult

patients with diabetes in Ethiopia: ROC analysis[J]. PLoS

One, 2022, 17(11): e0273786.

[58]中华人民共和国国家卫生健康委员会医政司.肥

胖症中国诊疗指南（2024年版）[J/OL].协和医学杂志，

2025，1-60.

[59]Blüher M. Obesity: global epidemiology and

pathogenesis[J]. Nat Rev Endocrinol, 2019, 15: 288-298.

[60]Bhupathiraju SN, Hu FB. Epidemiology of obesity

and diabetes and their cardiovascular complications[J]. Circ

Res, 2016, 118: 1723-1735.

[61]Wormser D, Kaptoge S, Di Angelantonio E, et al.

Separate and combined associations of body-mass index and

abdominal adiposity with cardiovascular disease: collaborative

analysis of 58 prospective studies[J]. Lancet, 2011, 377: 1085-

1095.

[62]Huang LH, Liao YL, Hsu CH. Waist circumference

is a better predictor than body mass index of insulin resistance in

type 2 diabetes[J]. Obes Res Clin Pract, 2012, 6: e263-e346.

[63]Peters SAE, Bots SH, Woodward M. Sex differences

in the association between measures of general and central

adiposity and the risk of myocardial infarction: results from

the UK biobank[J]. J Am Heart Assoc, 2018, 7: e008507.

[64]Chen G, Levy D. Contributions of the Framingham

Heart Study to the Epidemiology of Coronary Heart

Disease[J]. JAMA Cardiology, 2016, 1: 825-830.

[65]黄恺，曾天舒，刘刚，等.中国成人2型糖尿病及糖尿病前期患者动脉粥样硬化性心血管疾病预防与管理专

家共识[J].中国糖尿病杂志，2023，31（9）：641-656.

[66]Nanayakkara N, Curtis AJ, Heritier S, et al. Impact

of age at type 2 diabetes mellitus diagnosis on mortality

and vascular complications: systematic review and metaanalyses[J]. Diabetologia, 2021, 64(2): 275-287.

[67]Liu G, Li YD, Hu Y, et al. Influence of lifestyle on

incident cardiovascular disease and mortality in patients with

diabetes mellitus[J]. J Am Coll Cardiol, 2018, 71: 2867-2876.

[68]Liu G, Hu Y, Zong G, et al. Smoking cessation and

weight change in relation to cardiovascular disease incidence

and mortality in people with type 2 diabetes: a populationbased cohort study[J]. Lancet Diabetes Endocrinol, 2020, 8:

125-133.

[69]周靖芳.2型糖尿病合并冠心病的发病率和危险

因素的研究[D].广西医科大学，2015.

[70]Shi R, Wu B, Niu Z, Sun H, Hu F. Nomogram

Based on Risk Factors for Type 2 Diabetes Mellitus Patients with

Coronary Heart Disease[C]. Diabetes, metabolic syndrome and

obesity: targets and therapy, 2020, 13: 5025-5036.

[71]Marso SP, McGuire DK, Zinman B, et al. Efficacy

and safety of degludec versus glargine in type 2 diabetes[J]. N

Engl J Med, 2017, 377(8): 723-732.

[72]Luo S, Zheng X, Bao W, et al. Real-world

effectiveness of early insulin therapy on the incidence of

cardiovascular events in newly diagnosed type 2 diabetes[J].

Signal Transduct Target Ther, 2024, 9(1): 154.

[73]廖玉华，余淼，袁璟，等.心力衰竭SGLT2抑

制剂临床应用的中国专家共识[J].临床心血管病杂志，

2022，38（8）：599-605.

[74]李远翥，罗素新，黄毕.钠-葡萄糖协同转运蛋

白2抑制剂对射血分数保留型心力衰竭的治疗进展[J].中

国心血管病研究，2023，21（8）：757-762.

[75]刘靖，周翔海.冠心病合并2型糖尿病患者的血

糖管理专家共识[J].中国循环杂志，2024，39（4）：342-

352.

[76]Rakipovski G, Rolin B, Nohr J, et al. The GLP-1

analogs liraglutide and semaglutide reduce atherosclerosis in

ApoE -/and LDLr -/mice by a mechanism that includes

inflammatory pathways[J]. JACC Basic Transl Sci, 2018, 3(6):

844-857.

[77]纪立伟，郭立新.胰高糖素样肽-1类药物的心血

管保护作用[J].中华糖尿病杂志，2020，12（8）：654-660.

[78]Verma S, Bain SC, Honoré JB, et al. Impact of

microvascular disease on cardiovascular outcomes in type 2

diabetes: results from the LEADER and SUSTAIN 6 clinical

trials[J]. Diabetes Obes Metab, 2020, 22(11): 2193-2198.

[79]Pu H, Li J, Wang P, et al. The death of the

circulatory system diseases in China: provincial socioeconomic

and environmental perspective[J]. Environ Sci Pollut Res Int,

2017, 24(11): 10381-10390.

[80]Xu Y, Lu J, Li M, et al. Diabetes in China part 1:

epidemiology and risk factors[J]. Lancet Public Health, 2024,

9(12): e1089-e1097.

[81]Zhang Y, et al. Combined lifestyle factors and risk

of incident type 2 diabetes and prognosis among individuals

with type 2 diabetes: a systematic review and meta-analysis of

prospective cohort studies[J]. Diabetologia, 2020, 63: 21-33.

[82]Wu J, Xun P, Tang Q, et al. Circulating magnesium

levels and incidence of coronary heart diseases, hypertension,

and type 2 diabetes mellitus: a meta-analysis of prospective

cohort studies[J]. Nutr J, 2017, 16.


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