超声造影联合血清Ficolin-3,FOXM1对2型糖尿病下肢动脉病变的诊断价值分析

Value of Contrast-Enhanced Ultrasound Combined with Serum Ficolin-3 and FOXM1 in the Diagnosis of Lower Limb Arterial Disease in Type 2 Diabetes Mellitus

目的超声造影联合血清纤维胶凝蛋白-3(Ficolin-3)、叉头框蛋白M1(FOXM1)对2型糖尿病(T2DM)下肢动脉病变的诊断价值分析。方法选取2022年2月至2023年2月我院收治的T2DM患者114例,以下肢动脉血管造影检查为金标准,将患者分为下肢动脉病变组23例(病变组)和无下肢动脉病变组91例(T2DM组),另选取同期于本院进行体检的健康志愿者91例为对照组。对患者及健康志愿者进行血清Ficolin-3、FOXM1及超声造影检查;ROC曲线分析血清Ficolin-3、FOXM1对T2DM下肢动脉病变的诊断价值;采用四格表法分析血清Ficolin-3、FOXM1、超声造影及3项联合对T2DM下肢动脉病变的诊断价值。结果病变组、T2DM组血清Ficolin-3水平显著高于对照组,且病变组血清Ficolin-3水平显著高于T2DM组(均P<0.05);病变组、T2DM组血清FOXM1水平显著低于对照组,且病变组血清FOXM1水平显著低于T2DM组(均P<0.05);血清Ficolin-3诊断T2DM下肢动脉病变的曲线下面积为0.868,敏感度为86.96%,特异度为75.82%,最佳截断值为35.12μg/ml;血清FOXM1诊断T2DM下肢动脉病变的曲线下面积为0.854,敏感度为82.61%,特异度为78.02%,最佳截断值为0.57;血清Ficolin-3、FOXM1检查结果与金标准均具有中度一致性(Kappa=0.480、0.481,均P<0.001);超声造影检查结果显示,T2DM下肢动脉病变的阳性检出率为73.91%,与金标准具有较高一致性(Kappa=0.631,P<0.001);3项联合检测的敏感度、漏诊率均显著优于超声造影单独诊断,准确度显著优于Ficolin-3、FOXM1单独诊断,差异均有统计学意义(均P<0.05)。结论血清Ficolin-3、FOXM1联合超声造影检查在T2DM下肢动脉病变诊断中的应用价值较高,进一步提升了诊断的敏感度、准确度,减少了误诊率。

Objective To analyze the diagnostic value of contrast-enhanced ultrasound(CEUS)combined with serum fibroin-3 and forkhead box protein M1(FOXM1)in lower limb arterial disease in type 2 diabetes mellitus(T2DM).Methods A total of 114 patients with T2DM admitted to our hospital from February 2022 to February 2023 were selected.They were separated into a lower limb artery disease group of 23 patients(lesion group)and a non lower limb artery disease group of 91 patients(T2DM group)through lower limb artery angiography to determine whether they had lower limb artery disease.Serum Ficolin-3,FOXM1,and contrast-enhanced ultrasound were performed on the patients;ROC curve was applied to analyze the diagnostic value of serum Ficolin-3 and FOXM1 for lower limb arterial lesions in T2DM;fourfold table was applied to analyze the diagnostic value of serum Ficolin-3,FOXM1,contrast-enhanced ultrasound,and a combination of three factors for lower limb arterial lesions in T2DM.Results The serum Ficolin-3 level in the lesion group and T2DM group was obviously higher than that in the control group,and the serum Ficolin-3 level in the lesion group was obviously higher than that in the T2DM group(P<0.05);the serum FOXM1 level in the lesion and T2DM groups was obviously lower than that in the control group,and the serum FOXM1 level in the lesion group was obviously lower than that in the T2DM group(P<0.05);the area under the curve of serum Ficolin-3 for diagnosing lower limb arterial lesions in T2DM is 0.868,with a sensitivity of 86.96%,a specificity of 75.82%,and an optimal cutoff value of 35.12μg/ml;the area under the curve of serum FOXM1 for diagnosing lower limb arterial lesions in T2DM is 0.854,with a sensitivity of 82.61%,a specificity of 78.02%,and an optimal cutoff value of 0.57;the results of serum Ficolin-3 and FOXM1 tests showed moderate consistency with the gold standard(Kappa values=0.480,0.481,P<0.001);the results of contrast-enhanced ultrasound examination showed that the positive detection rate of lower limb arterial lesions in T2DM was 73.91%,which was highly consistent with the gold standard(Kappa value=0.631,P<0.001);the sensitivity and missed diagnosis rate of the three combined tests were significantly better than those of single diagnosis with contrast-enhanced ultrasound,and the accuracy was significantly better than that of single diagnosis with Ficolin-3 and FOXM1(P<0.05).Conclusion The combination of serum Ficolin-3 and FOXM1 with contrast-enhanced ultrasound has high application value in the diagnosis of lower limb arterial lesions in T2DM,further improving the sensitivity and accuracy of diagnosis and reducing the misdiagnosis rate.