Clinical Significance Of Elevated CTnT In Patients With Type 2 Diabetes Whithout Acute Myocardial Infarction

Objective: To investigate the clinical significance of elevated cTnT in patients with type 2 diabetes mellitus whithout acute myocardial infarction . To provide a new thinking to prevent,early diagnose and to treat for the cardioascular complications of type 2 diabetes mellitus .Methods:Referering to the 24-hour urinary albumin excretion rates,the 180 patients with T2DM were choosed and the participants above-mentioned were without acute myo- cardial infarction, autoimmune diseases, blood systemic diseases, thyroid diseases, serious infection, of rheumatic heart disease, primary cardiomyopathy, primary nephro- pathy, severe hepatopathy during the past three months. The electrocardiogram and cTnT in the patients with serum cTnT beyond the scope of normal reference value in the first determination were determined repeatly to exclude the cases with acute myocardial infarction . According to the diabetes nephropathy Mogensen staging system,the diabetic patients researchede were devided into three groups: The group A was composed with the diabetic patients whose urinary albumin below 30mg/D(n:60). The group B was composed with the diabetic patients whose urinary albumin between 30 and 300mg/D group (n: 60). The group C was composed with the diabetic patients whose urinary albumin > 300mg/D or Cr above reference (n: 60). There was not statistically significance difference in gender constitute of the three groups. The diabetic patients researched were then divided into cTnT positive group and cTnT negative group according to determination values of cTnT.The serum cTnT,random blood glucose, fructose- amine, glycated hemoglobin,hepatic function,renal function,blood-fat, C reactive protein in all patients were determined. In 120-days follow-up, observe the incidence of cardiovascular events and death events in patients were observed,the relationship between the incidence and cTnT was analyzed.Results: (1)There were 25 patients with elevated cTnT among 180 cases of T2DM patients. Of them cTnT increased in one patient in group A whose Urinary albumin less than 30mg / D (60 cases) ; cTnT increased in 4 patients in group B(Urinary albumin between 30-300mg / D as group B,60 cases); cTnT increased in 20 patients in group C(Urinary albumin greater than 300mg / D or Scr higher than the reference value as C group,60 cases). (2)Of 25 patients with elevated cTnT 16 patients had cardiovascular events , 8 died and among the died patients 7 patients died of cardiovascular events. Among 155 patients with normal cTnT ,6 patients occurred cardiovascular events. Of them 4 died, 1 of which died of cardiovascular events. There was significant difference between wo groups (P <0.01). (3)CTnT positive and negative groups were compared as follows: there were not statistically significant differences in the means'comparative of TG, TC, LDL - c, FA and HbA1c ; cTnT positive group's CRP level was significantly higher than cTnT negative group (P < 0.05); cTnT positive group's Hb level was obviously lower than cTnT negative group (P < 0.01) and ALB level was also obviously lower than cTnT negative group's (P < 0.05); the majority of the patients in CTnT positive group were the aged, compared with cTnT negative group, the difference in age was statistically significant (P < 0.01).Conclusions: (1)With the progress of diabetic nephropathy, the positive rate of elevated cTnT increases.(2)Elevated cTnT which were related with myocardial injury induced by cardiac microangiopathy in type 2 diabetes patients can predict the patient mortality and the incidence of cardiovascular events.(3)Simply strictly controling blood glucose cannot effectively reduce their big vascular events' risks for elderly diabetic patients with highly cardioascular risk level .