sROC曲线评价多参数对2型糖尿病缺血性脑卒中的预警作用

Evaluation of sROC curve on multiparameters for prewarning ischemic cerebral stroke in T2DM

目的应用sROC曲线评价实验室多项指标对预测2型糖尿病(T2DM)初发缺血性脑卒中的实用价值。方法收集30例确诊的T2DM初级发生脑卒中患者、30例未发生脑卒中的T2DM患者,检测T2DM初发缺血性脑卒中患者血浆白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、白细胞介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)、血小板膜糖蛋白CD62及超敏C-反应蛋白(hs-CRP)、D-二聚体(D-D)、同型半胱氨酸(HCY),并以未发生脑卒中的T2DM患者和健康人作为对照,比较3组受试者上述指标水平,并用sROC曲线评价这些指标的临床应用价值。结果 T2DM初发缺血性脑卒中组各参数均高于T2DM无脑卒中组,差异有统计学意义;T2DM两组均高于健康对照组,差异有统计学意义。由sROC曲线可知,各参数对T2DM患者初发缺血性脑卒中诊断价值从高到低依次为hs-CRP、IL-10、HCY、IL-6、TNF-α、D-D、CD62、IL-18,曲线下面积分别为1.000、0.993、0.982、0.956、0.947、0.930、0.918、0.871。结论 IL-6、IL-10、IL-18、TNF-α、CD62、hs-CRP、D-D、HCY各参数均可以预测T2DM脑卒中,但灵敏度与特异性均较高的是hs-CRP、IL-10、HCY。

Objective To use the summary receiver operating characteristic （sROC ） curve to evaluate the practical value of the multiple laboratory indexes for predicting the first attack of ischemic cerebral stroke in type 2 diabetes mellitus（T2DM ） .Methods The blood samples were collected from the T 2DM patients with the first attack of ischemic cerebral stroke ,30 T2DM patients without stroke and 30 healthy persons as the controls .The IL‐6 ,IL‐10 ,IL‐18 ,TNF‐α,CD62 ,hs‐CRP ,D‐D and HCY were detected .The detection levels of above indexes were compared among 3 groups and their clinical application values were evaluated by the sROC curves .Results The levels of vari‐ous parameters in the T2DM patients with first attack of ischemic cerebral stroke were higher than those in the T2DM patients without stroke ,the differences had statistical significance ;the levels in the two groups of T2DM were higher than those in the normal healthy control group with statistical differences ;The sROC curves indicated that the values of the various parameters for diagnosing the first attack of ischemic cerebral stroke in turn were hs‐CRP ,IL‐10 ,HCY ,IL‐6 ,TNF‐α,D‐D ,CD62 and IL‐18 ,and the areas under the curve（AUC） were 1 .000 ,0 .993 ,0 .982 ,0 .956 , 0 .947 ,0 .930 ,0 .918 and 0 .871 .Conclusion The various parameters of IL‐6 ,IL‐10 ,IL‐18 ,TNF‐α,CD62 ,hs‐CRP ,D‐D and HCY can be used to predict the T2DM with ischemic cerebral stroke ,but hs‐CRP ,D‐D and HCY simultane‐ously have higher sensitivity and higher specificity .