糖尿病足患者并存冠心病的诊断评分系统的建立与评价

Establishment and Evaluation of Diagnostic Scoring System for Coronary Artery Disease in Patients with Diabetic Foot

目的：建立糖尿病足（DF）患者并存冠心病的诊断评分系统，并评价其应用效能。方法回顾性分析445例住院DF患者的临床资料，采用病例对照研究，根据是否存在冠心病分为2组：冠心病组（DF并存冠心病者，372例）和对照组（DF无冠心病者，73例）。对相关临床因素进行多因素Logistic回归分析，筛选DF患者并存冠心病的危险因素，依据危险因素比数比（OR）值分别赋予分值，建立DF患者并存冠心病的诊断评分系统。用受试者工作特性（ROC）曲线下面积检验该评分系统的应用效能。结果 Logistic回归分析结果显示，DF患者并存冠心病的危险因素为年龄、男性、糖尿病病程≥10年、踝臂指数（ABI）≤0.9、体重指数（BMI）≥25 kg/m2及慢性肾功能不全。依据OR值赋予年龄（〈50岁=0分，50~64岁=1分，≥65岁=2分）、性别（女性=0分，男性=2分）、糖尿病病程（〈10年=0分，≥10年=3分）、ABI（〉0.9=0分，≤0.9=2分）、BMI（〈25 kg/m2=0分，≥25 kg/m2=3分）、慢性肾功能不全（无=0分，有=3分）分值。评分系统ROC曲线下面积为0.758（0.682~0.835），标准误为0.039，冠心病的诊断点为7分。结论本研究建立的评分系统具有良好的诊断效能，该评分系统简单、实用，可为DF患者并存冠心病的诊断提供依据。

Objective To establish a diagnostic scoring system for coronary artery disease（CAD）in patients with diabetic foot（DF）and evaluate its application efficiency. Methods The clinical data of 445 DF inpatients were analyzed retrospectively in this case-control study. These patients were divided into the CAD group（n=372,DF with CAD）and the control group（n=73,DF without CAD）according to the presence or absence of CAD. Risk factors were screened from related clinical factors examined through multiple logistic regression analysis for CAD in patients with DF and were assigned according to odds ratio（OR）to establish the scoring system for diagnosis of CAD in patients with DF. Application efficiency of the di-agnostic scoring system was tested by calculating area under the receiver operating characteristic（ROC）curve. Results The multiple logistic re-gression analysis showed that risk factors for CAD in patients with DF were age,male sex,the duration of diabetes≥10 years,the ankle-brachial in-dex（ABI）≤0.9,body mass index（BMI）≥25 kg/m2 and chronic renal insufficiency. According to ORassigned age（〈50 years=0,50-64 years=1,≥65 years=2）,sex（female=0,male=2）,the duration of diabetes（〈10 years=0,≥10 years=3）,ABI（〉0.9=0,≤0.9=2）,BMI（〈25 kg/m2=0,≥25 kg/m2=3）and chronic renal insufficiency（absent=0,present=3）scores. Area under the ROC curve of the diagnostic score scheme was 0.758（0.682-0.835）,the standard error was 0.039,and the point of the diagnosis of CAD was 7. Conclusion The scoring system established in the study is efficacious,simple and practical,which provides an important reference for CAD in patients with DF.