2型糖尿病患者股动脉内膜中层厚度和踝臂指数对冠状动脉粥样硬化性心脏病的预测价值  

Predictive value of femoral artery intima-media thickness and ankle brachial index to coronary artery disease in patients with type 2 diabetes mellitus

作　　者：任苗苗 吴坚[3] Ren Miaomiao;Wu Jian

机构地区：[1]蚌埠医学院研究生院,233000 [2]焦作市第二人民医院内分泌科,454000 [3]上海中医药大学附属上海市中西医结合医院内分泌科,200082

出　　处：《中国心血管杂志》2017年第6期433-437,共5页Chinese Journal of Cardiovascular Medicine

基　　金：上海市虹口区卫计委课题(1404-04)~~

摘　　要：目的通过观察单纯2型糖尿病(T2DM)组、T2DM合并冠状动脉粥样硬化性心脏病(CAD)组临床资料、生化指标、股动脉内中膜厚度(FAIMT)、踝臂指数(ABI)的变化,评价FAIMT、ABI对T2DM患者CAD的预测价值。方法选取我院内分泌科住院的T2DM患者150例为研究对象,分为非CAD组(NCAD组)和CAD组,CAD组又根据冠状动脉病变支数分为单支病变组(CAD1组)和多支病变组(CAD2组),对其临床资料、生化指标、FAIMT、ABI及冠状动脉病变情况进行统计学分析。结果 HDL-C水平在NCAD、CAD1和CAD2三组之间差异有统计学意义(P<0.05)。NCAD组与CAD1组和CAD2组比较,ABI和FAIMT值差异均有统计学意义(P<0.01);而CAD1组与CAD2组相比,仅有FAIMT值差异有统计学意义(P<0.01)。多因素回归分析表明,ABI(β=-0.626,P<0.05)、FAIMT(β=1.309,P<0.01)是CAD发生的独立危险因素。ROC曲线分析发现FAIMT为0.875 mm时对CAD的预测价值最高,灵敏度为79%,特异度为92%,曲线下面积(AUC)为0.891(P<0.01);FAIMT为0.875 mm时对CAD1的诊断价值最高,灵敏度为76%,特异度为92%,AUC为0.845(P<0.01),95%可信区间为(0.766,0.927);FAIMT为1.025 mm时对CAD2的预测价值最高,灵敏度为60%,特异度为92%,AUC为0.818(P<0.01),95%可信区间为(0.748,0.889);ABI为0.99时,对NCAD的预测价值最高,AUC为0.789(P<0.01),灵敏度为76%,特异度为72%,但对CAD的阳性预测价值不高(AUC=0.211,P<0.5)。结论 FAIMT、ABI均是T2DM患者CAD的独立危险因素,二者对其诊断有一定的预测价值。Objective To explore the predictive value of femoral artery intima-media thickness （FAIMT）and ankle brachial index（ABI） to coronary artery disease（CAD） in patients with type 2 diabetes mellitus（T2DM）. Methods The 150 patients with T2DM were divided randomly into three groups,which were control group（NCAD,n =50）,the single coronary artery involved group（CAD1,n = 50）,and multivessel coronary artery involved group（CAD2,n = 50）. All patients＆#39; clinical data,biochemical indicators,levels of FAIMT and ABI were measured, and compared among the three groups. Results HDL-C level was significantly lower in patients from NCAD group than that of CAD2 group（P ＆lt;0. 05）. Meanwhile,values of ABI and FAIMT were significant different（P ＆lt; 0. 01） in the NCAD group compared with those in the CAD1 and CAD2 groups. Furthermore, FAIMT was significantly different between the CAD1 and CAD2 groups （ P ＆lt;0. 01）. Multiple factors regression analysis showed that ABI（β = -0. 626,P ＆lt;0. 05）and FAIMT（β = 1. 309,〈0. 01）were independent risk factors for CAD. ROC curve analysis demonstrated that a FAIMT cut point of 0. 875 mm was the highest prognostic value to the CAD [area under the curve（AUC）0. 891,sensitivity 79% , specificity 92% ,P ＆lt; 0. 01], and was also the best cutoff level for CAD1 （ AUC 0. 845, sensitivity 76% , specificity 92% ,P ＆lt;0. 01）. The FAIMT cutoff level of 1. 025 mm had the greatest accuracy value for CAD2 （AUC 0. 818,sensitivity 60% ,specificity 92% ,P ＆lt;0. 01）. In addition,ABI cutoff level of 0. 99 had the highest negative predictive value for CAD（AUC 0. 789,sensitivity 76% ,specificity 72% ,P ＆lt;0. 01）,though ABI levels were not useful for predicting CAD （ AUC = 0. 211, P ＆lt; 0. 05）. Conclusions FAIMT and ABI are independent risk factors of CAD in T2DM and have a certain predictive value to CAD.

关 键 词：糖尿病 2型 冠状动脉疾病 内膜中层厚度 踝臂指数 

分 类 号：R541.4[医药卫生—心血管疾病]