复合自主神经症状评分-31在糖尿病心血管自主神经病变中的诊断价值

Composite autonomic symptom score-31 for the diagnosis of diabetic cardiovascular autonomic neuropathy

目的:探讨复合自主神经症状评分-31(composite autonomic symptom score-31,COMPASS-31)在2型糖尿病心血管自主神经病变(cardiovascular autonomic neuropathy,CAN)中的诊断价值。方法:收集2018年10月至2019年05月河南科技大学第一附属医院内分泌代谢科收治的2型糖尿病患者资料105例。根据心血管反射试验(cardiovascular reflex tests,CARTs)结果将患者分为CAN组(41例)和非CAN组(64例),比较2组间的临床特征及COMPASS-31得分情况。采用Pearson相关分析确定COMPASS-31评分与CARTs的相关性;通过logistic回归模型分析筛选CAN发生的危险因素,并建立多指标联合的诊断模型,运用ROC曲线评价COMPASS-31评分及联合模型对CAN的诊断价值。结果:CAN组患者COMPASS-31总得分明显高于非CAN组(P<0.001)。COMPASS-31总得分与CARTs指标相关性良好(P<0.05)。COMPASS-31总得分升高是CAN的独立危险因素。COMPASS-31总得分诊断CAN的最佳切点为大于19.5分,AUC值为0.788,敏感度为68.3%,特异度为79.7%。将COMPASS-31总得分引入一般危险因素模型后诊断CAN的AUC值显著提高(0.845 vs 0.905,P<0.05)。结论:COMPASS-31评分简便快速、临床操作性强,对2型糖尿病CAN具有一定的诊断价值,可作为一种CAN评估工具。

Objective:To investigate the diagnostic value of Composite Autonomic Symptom Score-31(COMPASS-31)in cardiovascular autonomic neuropathy(CAN)patients with type 2 diabetes mellitus.Methods:A total of 105 hospitalized patients with type 2 diabetes mellitus in the Department of Endocrinology and Metabolism,the First Affiliated Hospital of Henan University of Science and Technology from October 2018 to May 2019 were enrolled.41 cases were diagnosed as CAN,and the other 64 cases were non-CAN.The clinical characteristics and COMPASS-31 total scores between the two groups were compared.Pearson correlation analysis was used to determine the relationship between COMPASS-31 scores and CARTs parameters.Multivariate logistic regression model was used to analyze and screen the risk factors of CAN,and the combined models were established.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of COMPASS-31 score and combined models in CAN.Results:Patients with CAN had higher COMPASS-31 total score(P<0.001).The COMPASS-31 total score was closely correlated with CARTs parameters(P<0.05).Further analyses showed that increase of COMPASS-31 total score was an independent risk factor for CAN.The best cut-off point of COMPASS-31 total score identifying CAN was greater than 19.5 points(AUC 0.788,sensitivity 68.3%,specificity 79.7%).Incorporating COMPASS-31 total score into the general risk factor model significantly increased the AUC for diagnosis of CAN(0.845 vs 0.905,P<0.05).Conclusions:COMPASS-31 is simple,rapid,and easy to operate in clinic.It has a certain diagnostic value for CAN in patients with type 2 diabetes mellitus and might be used as an evaluation tool for CAN.