不同指标联合检测对2型糖尿病合并动脉粥样硬化性疾病的诊断价值  

Diagnostic value of combined detection of different indicators for type 2 diabetes mellitus combined with atherosclerotic disease

作　　者：姜雯雯[1] 牛金豆 祁媚姣[1] 宋雅伟[3] 党颖强 杨佩琦[1] 杨婧[1] 刘玉梅[1] Jiang Wenwen;Niu Jindou;Qi Meijiao;Song Yawei;Dang Yingqiang;Yang Peiqi;Yang Jing;Liu Yumei(Clinical Medical Center,Lanzhou University Second Hospital,Lanzhou 730030,China;Clinical Laboratory,Gansu Maternal and Child Health Hospital,Lanzhou 730050,China;Clinical Laboratory,the Second People′s Hospital of Lanzhou,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院检验医学中心,兰州730030 [2]甘肃省妇幼保健院检验科,兰州730050 [3]兰州市第二人民医院检验科,兰州730030

出　　处：《中华医学杂志》2021年第31期2448-2453,共6页National Medical Journal of China

基　　金：兰州大学第二医院“萃英科技创新”计划基金(CY2019-BJ14);甘肃省教育厅基金(2020B-045);甘肃省自然科学基金(18JR3RA328)。

摘　　要：目的探讨联合检测血清脂蛋白相关磷脂酶A2(Lp-PLA2)、淀粉样蛋白A(SAA)、免疫球蛋白E(IgE)对2型糖尿病(T2DM)合并动脉粥样硬化性疾病(AS)的诊断价值。方法选取2019年6至12月兰州大学第二医院T2DM患者224例,其中男144例,女80例,年龄(61±11)岁。按照影像学检查结果将患者分为T2DM合并AS组(T2DM-AS组,n=160)及T2DM组(n=64);选取同期本院健康体检者作为健康对照组(n=160)。检测所有患者及健康对照者的Lp-PLA2、IgE、SAA、超敏C反应蛋白(hs-CRP)、总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(Hcy)。分析上述各指标以及性别、年龄与T2DM合并AS的相关性;采用多因素logistic回归分析T2DM合并AS的危险因素。结果与健康对照组比较,T2DM-AS组、T2DM组的IgE、Lp-PLA2水平均升高,T2DM-AS组的SAA水平升高(均P<0.05);与T2DM组比较,T2DM-AS组Lp-PLA2、IgE、SAA水平均升高(均P<0.05)。T2DM合并AS与年龄、IgE、Lp-PLA2和SAA呈正相关(r=0.468、0.269、0.486、0.418,均P<0.05),与HDL-C呈负相关(r=-0.338,P<0.05)。多因素logistic回归分析显示,年龄(OR=0.865,95%CI:0.763~0.982,P<0.05)、IgE(OR=0.910,95%CI:0.840~0.987,P<0.05)和Lp-PLA2(OR=0.942,95%CI:0.910~0.986,P<0.05)与T2DM合并AS相关。Lp-PLA2、SAA和IgE联合检测可以提高对T2DM合并AS的诊断效能,曲线下面积(AUC)=0.895(P<0.05),敏感度为80.0%,特异度为93.7%。结论T2DM合并AS患者Lp-PLA2、IgE、SAA水平均升高,Lp-PLA2、SAA和IgE的联合检测可以提高对T2DM合并AS的诊断效能。Objective To investigate the diagnostic value of serum lipoprotein associated phospholipase A2(Lp-PLA2),amyloid A(SAA)and immunoglobulin E(IgE)in patients with type 2 diabetes(T2DM)mellitus complicated with atherosclerotic disease.Methods From June to December 2019,224 patients with T2DM in the Second Hospital of Lanzhou University were selected,including 144 males and 80 females,aged(61±11)years.According to the results of imaging examination,the patients were divided into T2DM with AS group(T2DM-AS group,n=160)and T2DM group(n=64);Healthy subjects in the same period were selected as healthy control group(n=160).Lp-PLA2,IgE,SAA,hs-CRP,TC,TG,HDL-C,LDL-C and Hcy were detected in all patients and healthy controls.The correlation between the above indexes,gender,age and T2DM with AS was analyzed;Multivariate logistic regression was used to analyze the risk factors of T2DM with AS.Results Compared with the healthy control group,the levels of IgE and Lp-PLA2 in T2DM-AS group and T2DM group were increased,and the levels of SAA in T2DM-AS group were increased(all P<0.05);Compared with T2DM group,the levels of Lp-PLA2,IgE and SAA were increased in T2DM-AS group(all P<0.05).T2DM with AS was positively correlated with age,IgE,Lp-PLA2 and SAA(r=0.468,0.269,0.486,0.418,all P<0.05),and negatively correlated with HDL-C(r=-0.338,P<0.05).Multivariate logistic regression analysis showed that age(OR=0.865,95%CI:0.763-0.982,P<0.05),IgE(OR=0.910,95%CI:0.840-0.987,P<0.05)and Lp-PLA2(OR=0.942,95%CI:0.910-0.986,P<0.05)were risk factors of T2DM with AS.ROC curve showed that the combined detection of Lp-PLA2,SAA and IgE could improve the diagnostic efficiency of T2DM with AS(AUC=0.895,P<0.05),the sensitivity was 80.0%,and the specificity was 93.7%.Conclusion The levels of Lp-PLA2,IgE and SAA increase in T2DM patients with AS.The combined detection of Lp-PLA2,SAA and IgE can improve the diagnostic efficiency of T2DM patients with AS.

关 键 词：糖尿病 2型 动脉粥样硬化 脂蛋白相关磷脂酶A2 血清淀粉样蛋白A 免疫球蛋白E 

分 类 号：R587.2[医药卫生—内分泌] R543.5[医药卫生—内科学]