尿11-脱氢-血栓素B_2对2型糖尿病患者冠状动脉病变的诊断价值研究

Value of Urinary 11-dehydro-thromboxane B_2 in the Diagnostic of Coronary Artery Lesions Among Type 2 Diabetics Patients

目的：探讨尿11-脱氢-血栓素 B2（11-DH-TXB2）对2型糖尿病患者冠状动脉病变的诊断价值。方法收集2014年11月—2015年10月中国人民解放军第305医院因胸闷、胸痛疑诊为冠心病或已明确诊断为冠心病行经皮冠状动脉介入治疗的2型糖尿病患者156例，根据冠状动脉造影检查结果分为2型糖尿病合并冠状动脉病变组（冠状动脉病变组）105例及单纯2型糖尿病组（对照组）51例。收集患者的性别、年龄、糖尿病病程、身高、体质量，计算体质指数（BMI），检测空腹血糖（FPG）、血脂、同型半胱氨酸（Hcy）、超敏 C 反应蛋白（hs-CRP）、糖化血红蛋白（HbA1c ）、D -二聚体（D-D）、纤维蛋白原（Fg）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、尿11-DH-TXB2水平，根据冠状动脉造影结果评价 Gensini 评分。采用受试者工作特征（ROC）曲线评价尿11-DH-TXB2诊断2型糖尿病患者冠状动脉病变的价值。结果对照组与冠状动脉病变组患者性别、BMI、FPG、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、HbA1c、Fg、TT 比较，差异均无统计学意义（ P＞0.05）；冠状动脉病变组患者年龄、糖尿病病程、低密度脂蛋白胆固醇（ LDL-C）、Hcy、hs-CRP、D-D、尿11-DH-TXB2水平高于对照组，PT、APTT 低于对照组（ P ＜0.05）。冠状动脉病变组患者 Gensini 评分为5～60分， Gensini 评分与年龄、糖尿病病程、Hcy、hs-CRP、D-D、尿11-DH-TXB2水平呈正相关（ r ＝0.259，P ＝0.001；r＝0.235，P ＝0.003；r ＝0.308，P ＜0.001；r ＝0.163，P ＝0.042；r ＝0.396，P ＜0.001；r ＝0.228，P ＝0.004），与APTT 呈负相关（r ＝-0.190，P ＜0.05）；Gensini 评分与 PT 无直线相关关系（r ＝-0.070，P ＝0.385）。多元线性逐步回归分析结果显示，糖尿病病程、Hcy、D-D、尿11-DH-TXB2水平进入方程，回归方程为 Gensini 评分＝-7.468＋0.378病程＋0.354Hcy ＋0.075D-D ＋2.731（尿11-DH-TXB2）。尿11-DH-TXB2诊断2型糖尿病患者冠状动脉病变的 ROC曲线下面积（AUC）为0.670〔95％ CI（0.582，0.758）〕，最佳临界点为3622 pg/ mgUcr，灵敏度为71.4％，特异度为68.6％，阳性预测值为82.4％、阴性预测值为53.9％。结论尿11-DH-TXB2作为一种安全、简便、灵敏的无创性检查方法，对2型糖尿病患者冠状动脉病变早期筛查具有一定的诊断价值。

Objective To discuss the value of urinary 11 - dehydro - thromboxane B2 （11-DH-TXB2 ）in the diagnostic of coronary artery lesions among type 2 diabetics patients. Methods 156 type 2 diabetic patients who were suspected to get coronary heart disease due to chest congestion or stethalgia,or were diagnosed with coronary heart disease and underwent percutaneous coronary intervention therapy in the 305 Hospital of PLA during November 2014 to October 2015,were divided into type 2 diabetes with coronary artery lesions group（coronary artery lesions group,105 cases）and simple type 2 diabetes group （control group,51 cases）according to the coronary angiography findings. The gender,age,course of diabetes,height,body mass,body mass index（BMI）,levels of fasting plasma glucose（FPG）,blood lipids,homocysteine（Hcy）,high sensitivity - C reactive protein（ hs-CRP）,glycated hemoglobin（ HbA1c ）,D-Dimer（ D-D）,fibrinogen（ Fg）,prothrombin time （PT）,activated partial thromboplastin time（ APTT）,throbin time（ TT）and urinary 11-DH-TXB2 level were recorded, Gensini scores were evaluated according to the coronary angiography findings. ROC curve was used to evaluate the value of urinary 11-DH-TXB2 in the diagnostic of coronary artery lesions among type 2 diabetes patients. Results There were no significant difference in gender,BMI,levels of FPG,TC,TG,HDL-C,HbA1c ,Fg and TT between coronary artery lesions group and control group（ P 〉 0. 05 ）. The age,course of diabetes,levels of LDL-C,Hcy,hs-CRP,D-D and urinary 11-DH-TXB2 among patients in coronary artery lesions group were significantly higher than those among patients in control group, while PT and APTT among patients in coronary artery lesions group were significantly shorter than those among patients in control group（P 〈 0. 05）. Gensini score in patients among coronary artery lesions group was from 5 to 60. Age,course of diabetes, levels of Hcy,hs-CRP,D-D and urinary 11-DH-TXB2 were positively correlated to the Gensini score（r = 0. 259,P = 0. 001;r= 0. 235,P = 0. 003;r = 0. 308,P 〈 0. 001;r = 0. 163,P = 0. 042;r = 0. 396,P 〈 0. 001;r = 0. 228,P = 0. 004）,while APTT was negatively correlated to the Gensini score（r = - 0. 190,P 〈 0. 05）. There was no correlation between Gensini score and PT（r = - 0. 070,P = 0. 385）. Multivariant linear stepwise regression analysis showed that course of diabetes,levels of Hcy,D-D and urinary 11-DH-TXB2 entered the regression equation,the regression equation was Gensini score = - 7. 468＋ 0. 378 course of diabetes ＋ 0. 354 Hcy ＋ 0. 075 D-D ＋ 2. 731 urinary 11-DH-TXB2 . The ROC curve of urinary 11-DH-TXB2 showed the area under ROC was 0. 670〔95% CI（0. 582,0. 758）〕,and the best cut point was 3 622 pg/ mgUcr yielded a good sensitivity（71. 4% ）and specificity（68. 6% ）. The positive predictive value and the negative predictive value were 82. 4%and 53. 9% . Conclusion As a safe,noninvasive,simple and sensitive method,urinary 11-DH-TXB2 level may be valuable in the early screening of coronary artery lesions among type 2 diabetes patients.