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【medical-news】特殊的CT扫描有助预测糖尿病患者的寿命

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http://www.sciencedaily.com/releases/2011/05/110523075307.htm

Common Test Could Help Predict Early Death in Diabetes, Study Shows

ScienceDaily (May 29, 2011) — New findings out of Wake Forest Baptist Medical Center reveal that a common test may be useful in predicting early death in individuals with diabetes. The study appears in the May issue of Diabetes Care.

"People with diabetes are already at high risk of developing heart disease and experiencing an early death," said Donald W. Bowden, Ph.D., the director of the Center for Diabetes Research at Wake Forest Baptist and lead investigator. "With this study, we've discovered that we can identify a subset of individuals within this high risk group who are at even higher risk, and the means to do this is already widely available in the form of a computed tomography (CT) scan -- a relatively inexpensive and non-invasive test."

More than 25 million Americans -- 8.3 percent of the population -- are currently living with diabetes, according to the National Institutes of Health. People with the condition are at increased risk of developing heart and vascular disease and, while vascular disease is common in the general population, it is twice as common in people with diabetes. At least 60 percent of diabetes patients -- even those on dialysis for kidney failure -- ultimately die of a vascular event, such as heart attack or stroke. However, Bowden said, questions about why so many diabetes patients die early have remained unanswered in the medical community's understanding of the disease.

For the Diabetes Heart Study, Bowden and colleagues have been following nearly 1,500 patients with diabetes in North Carolina for about 13 years, gathering data on various aspects of the disease and how it affects individual health. As original study participants began to die, the researchers sought to understand why.

"When we reviewed the data last year, we were shocked by the number of participants who had already died during this study," Bowden said. "We wanted to find out if there were any predictors of who would succumb versus those who are still living. In a group of people who are already at high risk, we were looking for a way to identify which individuals were at even higher risk for early death, with the goal of finding interventions or ways to focus medical care and attention toward those individuals at highest risk."

A high coronary artery calcium (CAC) score is known to be a strong indicator of coronary heart disease. The score provides a measure of how much coronary artery disease, or calcified "plaque" is present in the blood vessels of the heart. Plaque plays a major role in heart attacks and other vascular events and can be measured by taking a special "gated" CT scan which, in comparison to typical CT scans, uses very few X-rays, does not require any injections and generally takes less than 10 minutes to perform. At Wake Forest Baptist, the test costs just over $200 and some insurance companies will cover the exam in appropriate situations.

Within the diabetes-affected population, there is a very wide range of calcified plaque buildup in the arteries and the heart, from individuals with none at all, to people whose entire vessels are nearly completely calcified. The researchers separated more than 1,000 study participants into five groups, according to the amount of calcified plaque they had in their blood vessels at the beginning of the study. The health of those participants was then followed for an average of 7.4 years before researchers compared the data from those who died during the study to those who are still living.

"We saw a dramatic risk of dying earlier in the people with highest levels of calcified plaque in their blood vessels," Bowden said. "When comparing the group with the highest amount of plaque to the group that had the lowest amount of calcified plaque, the risk of dying was more than six times greater in the group with high levels of calcified plaque. The difference in risk that we revealed is striking. It's in a group of people who are already at risk, but the CAC level really rather dramatically differentiates risk between people within this high risk group. This finding could have novel clinical implications."

Diabetes is associated with many other medical problems, Bowden said, so identifying a way to determine who is at highest risk and who needs the most intensive medical monitoring and care is especially important.

"The striking magnitude of the risk suggests very strongly that other research samples should be evaluated, especially in individuals with diabetes," he said.

The study was funded by the National Heart, Lung, and Blood Institute, as well as the General Clinical Research Center of Wake Forest Baptist.

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• 一个读研期间执医四战四败的医学生内心独白

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Common Test Could Help Predict Early Death in Diabetes, Study Shows
研究显示常规检测可对糖尿病致早期死亡进行预测

ScienceDaily (May 29, 2011) — New findings out of Wake Forest Baptist Medical Center reveal that a common test may be useful in predicting early death in individuals with diabetes. The study appears in the May issue of Diabetes Care.
科学日报（2011年5月29日）---维克森林大学浸信会医学中心最近一项研究发现常规检测可用于对糖尿病个体早期死亡进行预测。这项研究报道发表在5月版的Diabetes Care杂志上。

"People with diabetes are already at high risk of developing heart disease and experiencing an early death," said Donald W. Bowden, Ph.D., the director of the Center for Diabetes Research at Wake Forest Baptist and lead investigator. "With this study, we've discovered that we can identify a subset of individuals within this high risk group who are at even higher risk, and the means to do this is already widely available in the form of a computed tomography (CT) scan -- a relatively inexpensive and non-invasive test."
文章主要作者、维克森林大学浸信会医学中心糖尿病研究中心主任Donald W. Bowden博士说：“糖尿病患者具有较高的发生心脏疾病以及出现早期死亡的风险。在这项研究中，我们发现可以采用现在使用很广泛的计算机断层（CT）扫描这种不算昂贵的非侵入性检测，来筛选出这类高风险群体中发生风险更高的那部分个体。”

More than 25 million Americans -- 8.3 percent of the population -- are currently living with diabetes, according to the National Institutes of Health. People with the condition are at increased risk of developing heart and vascular disease and, while vascular disease is common in the general population, it is twice as common in people with diabetes. At least 60 percent of diabetes patients -- even those on dialysis for kidney failure -- ultimately die of a vascular event, such as heart attack or stroke. However, Bowden said, questions about why so many diabetes patients die early have remained unanswered in the medical community's understanding of the disease.
根据美国国立卫生研究院的统计数据，美国有超过2500万人（占总人口的8.3%）患有糖尿病。糖尿病导致发生心血管疾病的风险增加，血管性疾病虽然属于普通人群中的常见疾病，但糖尿病患者的发生此类疾病风险是普通人群的2倍。糖尿病患者中有超过60%，甚至包括因肾功能衰竭需要进行透析的患者，最终死于心脏病发作或中风等心血管事件。然后，Bowden提到，目前医学对糖尿病的研究还未能解答为什么这么多患者发生早期死亡的问题。

For the Diabetes Heart Study, Bowden and colleagues have been following nearly 1,500 patients with diabetes in North Carolina for about 13 years, gathering data on various aspects of the disease and how it affects individual health. As original study participants began to die, the researchers sought to understand why.
在这项糖尿病心脏研究中，Bowden及其同事用了13年对北加州约1500位糖尿病患者进行了跟踪研究，收集了这种疾病病因以及该病如何影响患者个体健康方面的数据。由于最早参加该试验的参与者中开始出现死亡，研究人员试图去寻找其发生的原因。

"When we reviewed the data last year, we were shocked by the number of participants who had already died during this study," Bowden said. "We wanted to find out if there were any predictors of who would succumb versus those who are still living. In a group of people who are already at high risk, we were looking for a way to identify which individuals were at even higher risk for early death, with the goal of finding interventions or ways to focus medical care and attention toward those individuals at highest risk."
“去年我们对收集的数据进行了评价，一些在试验进行期间已经死亡的参与者数目令我们感到很震惊”，Bowden说，“我们希望能找到是否存在患者会死亡或能继续存活的预测指标。我们过去一直在探索能否找到一种方法可在这些发生风险较高的群体筛选出发生早期死亡风险更高的个体，目标是为发生风险最高的那些个体找到医疗救护及注意事项方面的治疗和方法。”

A high coronary artery calcium (CAC) score is known to be a strong indicator of coronary heart disease. The score provides a measure of how much coronary artery disease, or calcified "plaque" is present in the blood vessels of the heart. Plaque plays a major role in heart attacks and other vascular events and can be measured by taking a special "gated" CT scan which, in comparison to typical CT scans, uses very few X-rays, does not require any injections and generally takes less than 10 minutes to perform. At Wake Forest Baptist, the test costs just over $200 and some insurance companies will cover the exam in appropriate situations.
冠状动脉钙化（CAC）分数是已知的的心脏冠脉疾病发生风险的重要指标。这种评分提供了一种对心脏冠脉疾病数量及冠脉钙化斑块进行评价的方法。斑块在心脏病发作以及其它血管事件中起着重要作用，可以采用一种特殊“门控”CT对斑块进行扫描。与常规CT不同，这种“门控”CT使用较少的X-射线，不需要注射药物或造影剂，一般不到10分钟就能完成检测。在维克森林大学浸信会医学中心，这项检测只需200美元，在一些情况下可由保险公司支付全部费用。

Within the diabetes-affected population, there is a very wide range of calcified plaque buildup in the arteries and the heart, from individuals with none at all, to people whose entire vessels are nearly completely calcified. The researchers separated more than 1,000 study participants into five groups, according to the amount of calcified plaque they had in their blood vessels at the beginning of the study. The health of those participants was then followed for an average of 7.4 years before researchers compared the data from those who died during the study to those who are still living.
糖尿病患者中心脏和血管钙化斑块情况差异很大，有些患者完全没有钙化斑块，而有些患者血管几乎完全钙化。研究人员根据入选这项试验时参与者血管钙化斑块的数量，将1000多位参与人员分成5组，在研究人员对试验中死亡病例和任然存活的病例进行比较前，对受试者的平均随访时间为7.4年。

"We saw a dramatic risk of dying earlier in the people with highest levels of calcified plaque in their blood vessels," Bowden said. "When comparing the group with the highest amount of plaque to the group that had the lowest amount of calcified plaque, the risk of dying was more than six times greater in the group with high levels of calcified plaque. The difference in risk that we revealed is striking. It's in a group of people who are already at risk, but the CAC level really rather dramatically differentiates risk between people within this high risk group. This finding could have novel clinical implications."
“我们看到血管钙化斑块水平最高的患者的早期死亡风险大大提高，”，Bowden说，“与最少斑块数量的患者组相比，斑块数量最多的患者组死亡风险增长5倍多，我们发现的这种差异是惊人的。糖尿病患者本身风险就很高，但是冠状动脉钙化水平能较好的区分这些高风险人群中风险差别。这项发现可以成为新的临床应用方法。”

Diabetes is associated with many other medical problems, Bowden said, so identifying a way to determine who is at highest risk and who needs the most intensive medical monitoring and care is especially important.
Bowden提到糖尿病与多种其他疾病相关，因此找到一种筛选出哪些人风险最高、需要密切监测和护理的方法极其重要。

"The striking magnitude of the risk suggests very strongly that other research samples should be evaluated, especially in individuals with diabetes," he said.
“这种惊人的风险等级说明很需要对其他，尤其是糖尿病患者个体的样本进行评价。”Bowden说。

The study was funded by the National Heart, Lung, and Blood Institute, as well as the General Clinical Research Center of Wake Forest Baptist.
这项研究得到了国家心肺血液研究所以及维克森林大学浸信会医学中心全科医学研究中心的资助。

重新整理后为（共1272中文字）：

研究显示常规检测可对糖尿病致早期死亡进行预测

科学日报（2011年5月29日）---维克森林大学浸信会医学中心最近一项研究发现常规检测可用于对糖尿病个体早期死亡进行预测。这项研究报道发表在5月版的Diabetes Care杂志上。

文章主要作者、维克森林大学浸信会医学中心糖尿病研究中心主任Donald W. Bowden博士说：“糖尿病患者具有较高的发生心脏疾病以及出现早期死亡的风险。在这项研究中，我们发现可以采用现在使用很广泛的计算机断层（CT）扫描这种不算昂贵的非侵入性检测，来筛选出这类高风险群体中发生风险更高的那部分个体。”

根据美国国立卫生研究院的统计数据，美国有超过2500万人（占总人口的8.3%）患有糖尿病。糖尿病导致发生心血管疾病的风险增加，血管性疾病虽然属于普通人群中的常见疾病，但糖尿病患者的发生此类疾病风险是普通人群的2倍。糖尿病患者中有超过60%，甚至包括因肾功能衰竭需要进行透析的患者，最终死于心脏病发作或中风等心血管事件。然后，Bowden提到，目前医学对糖尿病的研究还未能解答为什么这么多患者发生早期死亡的问题。

在这项糖尿病心脏研究中，Bowden及其同事用了13年对北加州约1500位糖尿病患者进行了跟踪研究，收集了这种疾病病因以及该病如何影响患者个体健康方面的数据。由于最早参加该试验的参与者中开始出现死亡，研究人员试图去寻找其发生的原因。

“去年我们对收集的数据进行了评价，一些在试验进行期间已经死亡的参与者数目令我们感到很震惊”，Bowden说，“我们希望能找到是否存在患者会死亡或能继续存活的预测指标。我们过去一直在探索能否找到一种方法可在这些发生风险较高的群体筛选出发生早期死亡风险更高的个体，目标是为发生风险最高的那些个体找到医疗救护及注意事项方面的治疗和方法。”

冠状动脉钙化（CAC）分数是已知的的心脏冠脉疾病发生风险的重要指标。这种评分提供了一种对心脏冠脉疾病数量及冠脉钙化斑块进行评价的方法。斑块在心脏病发作以及其它血管事件中起着重要作用，可以采用一种特殊“门控”CT对斑块进行扫描。与常规CT不同，这种“门控”CT使用较少的X-射线，不需要注射药物或造影剂，一般不到10分钟就能完成检测。在维克森林大学浸信会医学中心，这项检测只需200美元，在一些情况下可由保险公司支付全部费用。

糖尿病患者中心脏和血管钙化斑块情况差异很大，有些患者完全没有钙化斑块，而有些患者血管几乎完全钙化。研究人员根据入选这项试验时参与者血管钙化斑块的数量，将1000多位参与人员分成5组，在研究人员对试验中死亡病例和任然存活的病例进行比较前，对受试者的平均随访时间为7.4年。

“我们看到血管钙化斑块水平最高的患者的早期死亡风险大大提高，”，Bowden说，“与最少斑块数量的患者组相比，斑块数量最多的患者组死亡风险增长5倍多，我们发现的这种差异是惊人的。糖尿病患者本身风险就很高，但是冠状动脉钙化水平能较好的区分这些高风险人群中风险差别。这项发现可以成为新的临床应用方法。”

Bowden提到糖尿病与多种其他疾病相关，因此找到一种筛选出哪些人风险最高、需要密切监测和护理的方法极其重要。

“这种惊人的风险等级说明很需要对其他，尤其是糖尿病患者个体的样本进行评价。”Bowden说。

这项研究得到了国家心肺血液研究所以及维克森林大学浸信会医学中心全科医学研究中心的资助。

2011-06-03 08:22