冠状动脉CT及颈动脉超声在2型糖尿病合并冠心病风险预测中的价值

Value of coronary artery CT and carotid ultrasound in predicting the risk of type 2 diabetes mellitus complicated with coronary heart disease

目的:比较临床风险评估系统(UKPDS、FRS)、钙化积分(CACS)、冠脉CT血管成像(GCS)及颈动脉超声对2型糖尿病(T2DM)合并冠心病(CAD)风险预测的价值。方法:收集本院T2DM病例资料进行回顾性分析,将病例按照性别进行分组,对UKPDS、FRS、CACS、GCS、风险等级积分(LS)进行多因素Logistic回归分析,并计算各个危险因素对T2DM合并CHD诊断的敏感性、特异性及准确率。结果:男性组103例,女性组60例,其中64例为T2DM合并CAD。男性组T2DM合并CAD的独立危险因素包括CACS(OR=1.012)、GCS(OR=1.632)、LS(OR=1.447);女性组T2DM合并CAD的独立危险因素UKPDS(OR=1.088)、CACS(OR=1.008)及GCS(OR=1.651)。CACS、GCS与LS对男性组T2DM合并CAD具有诊断价值(AUC=0.789,0.975,0.671);UKPDS、CACS、GCS对女性组DM合并CAD具有诊断价值(AUC=0.673,0.847,0.984)。结论:在对T2DM合并CAD的诊断价值中,GCS价值最高,UKPDS、FRS、LS及CACS在不同性别间存在差异。

Objective:To compare the value of clinical risk assessment system(UKPDS,FRS),calcification score(CACS),coronary CTA(Gensini CAD score,GCS),and carotid ultrasound in predicting the risk of type 2 diabetes mellitus(T2 DM)with coronary heart disease(CHD).Methods:The data of T2 DM cases in our hospital were retrospectively analyzed.The cases were divided into male group and female group.UKPDS,FRS,CACS,GCS,and LS were analyzed by multivariate logistic regression.The sensitivity,specificity,and accuracy of various risk factors in the diagnosis of T2 DM combined with CHD were calculated.Results:There were 103 males and 60 females,64 of whom were T2 DM with CHD.CACS(OR=1.012),GCS(OR=1.632),and LS(OR=1.447)were all independent risk factors for T2 DM with CHD in the male group;UKPDS(OR=1.088),CACS(OR=1.008)and GCS(OR=1.651)were all independent risk factors for DM with CHD in the female group.CACS,GCS and LS had diagnostic value for T2 DM with CHD in the male group(AUC=0.789,0.975,0.671);UKPDS,CACS,and GCS have diagnostic value for DM with CHD in female group(AUC=0.673,0.847,0.984).Conclusion:Among the diagnostic value of diabetes combined with CHD,GCS was the highest,and there were significant gender differences between UKPDS,FRS,LS,and CACS.