股动脉内膜中层厚度和踝臂指数对糖尿病合并缺血性脑卒中患者的预测价值

Predictive value of femoral artery intima-media thickness and ankle brachial index in patients with diabetes and ischemic stroke

目的比较糖尿病合并缺血性脑卒中患者与单纯2型糖尿病(T2DM)患者的生化指标、股动脉内膜中层厚度(FAIMT)、踝臂指数(ABI)的差异,探讨FAIMT、ABI对糖尿病合并缺血性卒中的预测价值。方法收集2019年1月-2020年10月在新疆医科大学第七附属医院住院的T2DM患者临床资料,根据纳入及排除标准筛选病例,最终共纳入236例研究对象。根据脑核磁结果分为糖尿病合并缺血性脑卒中组(试验组)和单纯糖尿病组(对照组),收集性别、年龄、体重、身高、体重指数(BMI)、心率、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressures,DBP)、糖尿病病程、吸烟史、用药史等基本情况,测定血管硬化指标[臂踝脉搏波速度(branchial ankle pulse wave velocity,baPWV)、股动脉内膜中层厚度(Intimal media thickness of femoral artery,FAIMT)、踝肱指数(ankle brachial index,ABI)]、糖脂代谢指标[糖化血红蛋白(glycolated hemoglobin A1c,HbA1c)、空腹血糖(fasting blood glucose,FBG)、餐后2 h血糖(2 h-postprandial glucose,2 h PG)、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceide,TG)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)]以及同型半胱氨酸(homocysteine,HCY)、尿酸(uric acid,UA)、高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)等指标。结果两组患者年龄、性别、糖尿病病程、体重、BMI、心率、血压、吸烟史、胰岛素剂量差异均无统计学意义(P>0.05)。试验组的FAIMT[(1.08±0.06)mm vs(0.76±0.12)mm]、FBG[(8.23±1.23)mmol/L vs(7.85±0.89)mmol/L]高于对照组,而ABI[(0.93±0.23)vs(1.09±0.10)]、HDL-C[(1.10±0.12)mmol/L vs(1.14±0.1)mmol/L]低于对照组,差异均有统计学意义(P<0.05)。Pearson相关性分析显示,baPWV与年龄、性别、hs-CRP呈正相关(r=0.025,P<0.05;r=0.012,P<0.05;r=0.185,P<0.05);ABI与LDL-C呈正相关(r=0.154,P<0.05);FAIMT与BMI、SBP呈正相关(r=0.337,P<0.001;r=0.270,P<0.05)。二分类Logistic回归分析结果显示,ABI是糖尿病缺血性脑卒中发生的独立危险因素(相关系数为-0.85,P<0.01);当ABI为0.94时,对脑卒中的预测价值最好,灵敏度为83%,特异度为88%,AUC曲线为0.857,95%可信区间(0.779,0.869)。结论ABI是糖尿病合并缺血性脑卒中的独立危险因素,具有一定的预测价值。但FAIMT不是缺血性脑卒中的独立危险因素,且不具有阳性预测价值。

Objective To compare the differences in biochemical indexes,intima-media thickness of femoral artery(FAIMT)and ankle-brachial index(ABI)between diabetes mellitus complicated with ischemic stroke and type 2 diabetes mellitus(T2DM)alone,and to explore the predictive value of FAIMT and ABI in diabetes mellitus complicated with ischemic stroke.Methods To collect the clinical data of T2DM patients admitted to the Seventh Affiliated Hospital of Xinjiang Medical University from Jan 2019 to Oct 2020.A total of 236 subjects were included in the study according to inclusion and exclusion criteria.According to brain scans by magnetic resonance imaging(MRI),patients were divided into diabetic group with ischemic stroke(experimental group)and simple diabetic group(control group).General clinical data and vascular sclerosis index:brachial ankle pulse wave velocity(baPWV),intimalmedia thickness of femoral artery(FAIMT),ankle brachial index(ABI)were determined.Results There were no significant differences in age,sex,course of diabetes,body weight,BMI,heart rate,blood pressure,smoking history,and insulin dose between two groups(P>0.05).The levels of FAIMT([1.08±0.06)mm vs(0.76±0.12)mm]and FBG([8.23±1.23)mmol/L vs(7.85±0.89)mmol/L]in the experimental group were higher than those in the control group.While the levels of ABI([0.93±0.23)vs(1.09±0.10)]and HDL-C([1.10±0.12)mmol/L vs(1.14±0.10)mmol/L]in the experimental group were lower than those in the control group(P<0.05).Pearson correlation analysis showed that baPWV was positively correlated with age,sex and hs-CRP,(r=0.025,P<0.05;r=0.012,P<0.05;r=0.185,P<0.05),ABI was positively correlated with LDLC(r=0.154,P<0.05),FAIMT was positively correlated with BMI and SBP(r=0.337,P<0.001;r=0.270,P<0.05).Classified Logistic regression analysis showed that ABI was an independent risk factor for diabetic ischemic stroke,(P<0.01).When ABI was 0.94,it had the best predictive value for stroke,with sensitivity of 83%,specificity of 88%,AUC curve of 0.857,95%confidence interval(0.779,0.869).Conclusion ABI is the independent risk factor for diabetes with ischemic stroke,having certain predictive value.However,FAIMT is not an independent risk factor for ischemia stroke,and which has no positive predictive value.