2型糖尿病合并脑小血管病变患者病情严重程度的影响因素分析

Analysis on influencing factors of severity in patients with type 2 diabetes mellitus complicating cerebral small vessel disease

目的筛选和分析2型糖尿病(T2DM)合并脑小血管病变(CSVD)患者病情严重程度的影响因素。方法选取南京市中医院2018年6月至2023年5月收治的519例T2DM合并CSVD患者。根据CSVD影像学评分将患者分为轻度组(n=214)和重度组(n=305)。收集相关人口学、实验室、影像学指标资料。通过LASSO和logistic回归分析筛选出T2DM合并CSVD患者病情严重程度的影响因素,建立预测模型。绘制受试者工作特征(ROC)曲线及拟合优度评估,限制性立方样条(RCS)拟合曲线分析胱抑素C(Cys C)、白蛋白/球蛋白(A/G)与患者病情严重程度的量效关系。结果重度组男性占比、年龄大于轻度组,中性粒细胞、系统免疫炎症指数(SII)、肌酐(Crea)、尿酸(UA)、尿素(Urea)、D-二聚体(D-D)、乳酸脱氢酶(LDH)、腺苷脱氨酶(ADA)、球蛋白(GLB)、Cys C水平高于轻度组,淋巴细胞、ALT、高密度脂蛋白胆固醇(HDL-C)、血清胆碱酯酶(CHE)、前白蛋白(PAB)、A/G水平低于轻度组,差异有统计学意义(P<0.05)。LASSO和logistic回归分析显示,性别、年龄、A/G、Cys C是T2DM合并CSVD患者病情严重程度的独立影响因素。该模型曲线下面积(AUC)为0.658(95%CI:0.610~0.706),拟合良好(P=0.520)。RCS拟合曲线显示,Cys C≥0.618 mg/L与患者CSVD影像学评分呈线性关系(P=0.035),A/G≥1.268与患者CSVD影像学评分呈非线性关系(P=0.007)。结论高龄、男性、Cys C升高、A/G下降是T2DM合并CSVD患者病情严重程度的独立危险因素。

Objective To screen and analyze the influencing factors of severity in the patients with type 2 diabetes mellitus(T2DM)complicating cerebral small vessel disease(CSVD).Methods A total of 519 patients with T2DM complicating CSVD admitted and treated in Nanjing Municipal Hospital of Traditional Chinese Medicine from June 2018 to May 2023 were selected and divided into the mild group(n=214)and the severe group(n=305)according to the CSVD imageological score.The relevant demographic,laboratory and imageological indicators were collected.The influencing factors of T2DM complicating CSVD were screened out by the LASSO and Logistic regression analysis and the predictive model was established.The receiver operating characteristic(ROC)curve,goodness of fit evaluation and restricted cubic spline(RCS)fitting curve were drawn to analyze the dose-response relationship between Cys C,albumin/globulin(A/G)ratio with the disease severity.Results The male proportion and age in the severe group were greater than those in the mild group,neutrophil,systemic immune-inflammation index(SII),creatinine(Crea),uric acid(UA),Urea(Urea),D-dimer(D-D),lactate dehydrogenase(LDH),adenosine deaminase(ADA),globulin(GLB)and Cys C were higher than those in the mild group,lymphocyte,ALT,High density Lipoprotein-cholesterol(HDL-C),serum cholinesterase(CHE),prealbumin(PAB),and A/G were lower than those in the mild group,and the differences were statistically significant(P<0.05).LASSO and logistic regression analysis showed that the gender,age,A/G and Cys C were the independent influencing factors in the patients with T2DM complicating CSVD.The area under the curve(AUC)of this model was 0.658(95%CI:0.610-0.706)with goodness of fit(P=0.520).The RCS fitting curves showed that serum Cys C≥0.618 mg/L had a linear relationship with CSVD imageological score(P=0.035),and A/G≥1.268 had a nonlinear relationship with CSVD imageological score(P=0.007).Conclusion The advanced age,male,increased Cys C level and decreased A/G in the patients with T2DM complicating CSVD are the independent risk factors for the severity of whole brain damage.