2型糖尿病患者下肢动脉狭窄预测模型的建立

Construction of predictive models for lower limb artery stenosis in patients with type 2 diabetes

目的构建2型糖尿病患者下肢动脉狭窄的预测模型。方法对4368例2型糖尿病患者行下肢血管超声筛查和血生化检查。根据下肢动脉超声检查结果，分为狭窄组（狭窄率≥50％）和非狭窄组。根据二元回归分析结果，对下肢动脉狭窄危险因素进行评分，分别建立一般临床特点模型和一般临床特点联合血生化指标模型。采用受试者工作特征（ROC）曲线分析2种模型的预测效能。结果多元Logistic回归分析提示性别、年龄、糖尿病病程、高血压病、血糖控制不佳和低高密度脂蛋白一胆固醇（HDL—C）与下肢动脉狭窄相关。2个模型曲线下面积分别为0．77（0．74～0．80）和0．78（0．75～0．81）（均P=0．000）；但2个模型ROC曲线下面积比较，差异无统计学意义。评分≥7和≥10两个模型有最佳的灵敏度（86％和74％）和特异度（59％和68％）。结论一般临床特点可以较好地预测下肢动脉狭窄；当评分≥7分，建议行下肢血管超声等检查以排除下肢动脉狭窄。

Objective To construct predictive models for lower limb artery stenosis in patients with type 2 diabetes. Methods A total of 4 368 patients with type 2 diabetes underwent ultrasonography examination of lower limb arteries and serum biochemical assay and were assigned to the stenosis group （the stenosis rate 〉 50%） and non-stenosis group according to the results of ultrasonography examination of lower limb arteries. Risk factors for lower limb artery stenosis were rated according to the results of binary regression analysis. The model of general clinical characteristics and the model of general clinical characteristics combined with biochemical indices were constructed. Receiver operating characteristic （ROC） curves were used to analyze the predictive potency of two models. Results Multiple Logistic regression analysis indicated that gender, age, course of diabetes, hypertension, poor blood glucose control, and decreased HDL-C level were associated with lower limb artery stenosis. The areas under ROC curves of the two models were 0.77 （0.74 -0.80） and 0.78 （0.75 - 0.81） （P=0. 000）, respectively. The difference in the area under ROC curve between two models was not statistically significant. Models with scores ≥ 7 and ≥ 10 had the best sensitivity （86%and 74% ） and specificity （59% and 68%）. Conclusion General clinical characteristics can effectively predict the lower limb artery stenosis. For scores ≥7, examinations such as lower limb artery ultrasonography are recommended to exclude the lower limb artery stenosis.