基于PSM分析联合检测血浆纤维蛋白原和D-二聚体预测T2DM并发脑卒中的价值  

Value of combined determination of plasma fibrinogen and D-dimer in predicting type 2 diabetes mellitus complicated by stroke:A study based on propensity score matching

作　　者：孙元晓 倪钦帅 王婷婷 梁凤[3] 汪贯习[3] SUN Yuanxiao;NI Qinshuai;WANG Tingting;LIANG Feng;WANG Guanxi(Institute of Integrative Medicine,Qingdao University Medical College,Qingdao 266021,China)

机构地区：[1]青岛大学医学部中西医结合中心,山东青岛266021 [2]莒南县中医医院神经内科 [3]青岛大学医学院松山医院放射科

出　　处：《青岛大学学报（医学版）》2024年第2期274-278,共5页Journal of Qingdao University(Medical Sciences)

基　　金：青岛大学医疗集团科研专项基金(2020-34)。

摘　　要：目的探讨血浆纤维蛋白原(Fg)和D-二聚体(DD)联合检测对2型糖尿病(T2DM)病人并发脑卒中的预测价值。方法选取2017年1月-2019年1月莒南县中医医院神经内科的126例T2DM并发脑卒中恢复期病人作为观察组,211例单纯T2DM病人作为T2DM组,50例体检健康者作为正常组,收集所有受试者的人口学资料、既往病史、病程、并发症、血糖、糖化血红蛋白、血压、血脂、血浆Fg和DD等资料。运用倾向性评分匹配(PSM)法对观察组和T2DM组病人进行1∶1匹配(卡钳值=0.02),分析血浆Fg和DD单独以及联合检测预测T2DM病人并发脑卒中的价值。结果PSM前后,观察组病人血浆Fg和DD水平均显著高于T2DM组(Z=3.12~7.36,P<0.01)。多元Logistics回归分析显示,血浆Fg(OR=1.489,95%CI=1.094~2.025,P=0.011)和血浆DD(OR=1.009,95%CI=1.004~1.014,P=0.001)水平是T2DM病人脑卒中发生的风险因素。受试者工作特征曲线分析显示,血浆Fg和DD联合检测对T2DM病人脑卒中的发生有预测意义(曲线下面积为0.883,灵敏度为78.57%,特异度为94.64%),且联合检测的价值显著高于二者单独检测。结论T2DM并发脑卒中病人血浆Fg、DD水平显著升高,二者联合检测可提高T2DM病人并发脑卒中的风险预测效能。Objective To explore the value of combined determination of plasma fibrinogen(Fg)and D-dimer(DD)in predicting stroke in patients with type 2 diabetesmellitus(T2DM).Methods A total of 126 patients with T2DM in the convalescence stage of stroke who were treated in Department of Neurology,Junan Hospital of Traditional Chinese Medicine,from January 2017 to January 2019 were enrolled as observation group,211 patients with T2DM alone were enrolled as T2DM group,and 50 individuals receiving physical examination were enrolled as normal group.Related data were collected from all subjects,including demographic data,past medical history,course of disease,complications,blood glucose,glycosylated hemoglobin,blood pressure,blood lipids,plasma Fg,and DD.The propensity score matching(PSM)method was used to match the observation group and the control group at a ratio of 1∶1(caliper=0.02),and the value of plasma Fg and DD alone orin combination in predicting stroke in T2DM patients was analyzed.Results Before and after PSM,the observation group had significantly higher plasma levels of Fg and DD than the T2DM group(Z=3.12-7.36,P<0.01).The multivariate Logistic regression analysis showed that plasma Fg(OR=1.489,95%CI=1.094-2.025,P=0.011)and plasma DD(OR=1.009,95%CI=1.004-1.014,P=0.001)were risk factors for stroke in patients with T2DM.The receiver operating characteristic(ROC)curve analysis showed that combined determination of plasma Fg and DD had a certain value in predicting the onsetof stroke in patients with T2DM,with an area under the ROC curve of 0.883,a sensitivity of 78.57%,and a specificity of 94.64%,and the value of combined determination was significantly better than that of plasma Fg or DD alone.ConclusionThere are significant increases in the plasma levels of Fg and DD in patients with T2DM complicated by stroke,and combined determination of plasma Fg and DD can improve the performance in predicting stroke in T2DM patients.

关 键 词：糖尿病 2型 卒中 纤维蛋白原 D-二聚体 预测 

分 类 号：R587.1[医药卫生—内分泌] R743[医药卫生—内科学]