超声诊断糖尿病脑血管病变及与Hcy、CysC及vWF相关性研究

Ultrasound Diagnosis of Diabetic Cerebrovascular Disease and Its Correlation with Hcy, CysC and vWF

目的:研究超声对糖尿病合并缺血性脑血管疾病的诊断效果,并分析疾病与血清Hcy、CysC及vWF水平相关性,以期为糖尿病脑血管病的诊断提供一定的临床依据。方法:以糖尿病合并缺血性脑血管病患者为研究组,体检健康者为对照组,分别采用经颅多普勒超声(Transcranial Doppler, TCD)和CT血管造影(CT angiography,CTA)对研究组患者进行检查,分析TCD与CTA检查结果的一致性,并对两组研究对象的血清同型半胱氨酸(Homocysteine,Hcy)、胱抑素(Cystatin,Cys C)以及血管性血友病因子(Von Willebrand factor,vWF)水平进行检测,对危险因素进行分析。结果:TCD对血管重度狭窄的灵敏度、阳性预测值和Kappa值最高,阳性似然比为74.52>10,表明TCD对于糖尿病合并重度脑血管狭窄的检测与CTA的一致性最好。Hcy、Cys C及vWF水平均显著升高(P<0.05),其中研究组Hcy水平为24.28±4.01μmol/L,显著高于对照组的10.31±1.45μmol/L,研究组Cys C水平为1.45±0.21 mg/L,显著高于对照组的0.80±0.16 mg/L,研究组vWF水平为152.88±15.73%,显著高于对照组的92.31±16.21%。多因素回归分析显示,Hcy、Cys C及vWF均可作为独立预测指标,与患者疾病程度显著相关,对诊断和预后有一定的预测作用。结论:超声在糖尿病脑血管病的诊断中有较高的灵敏度和特异度,有重要的诊断意义,Hcy、Cys C及vWF均可作为糖尿病脑血管病的独立预测指标,与患者疾病程度显著相关。

Objective:To study the diagnostic effect of ultrasound on diabetes complicated with ischemic cerebrovascular disease,and analyze the correlation between the disease and serum Hcy,CysC and vWF levels,in order to provide a certain basis for the diagnosis of diabetic cerebrovascular disease.Methods:Diabetes patients with ischemic cerebrovascular disease were taken as the study group,and healthy persons were taken as the control group.TCD and CTA were used to examine the patients in the study group.The consistency of the results of TCD and CTA was analyzed,and the results of the two groups were analyzed.Serum Hcy,CysC and vWF levels were detected,and risk factors were analyzed.Results:TCD has the highest sensitivity,positive predictive value and Kappa-coefficientfor severe vascular stenosis,and the positive likelihood ratio is 74.52>10,indicating that TCD has the best consistency with CTA for the detection of diabetes with severe cerebrovascular stenosis.The levels of Hcy,CysC and vWF were significantly increased(P<0.05).The level of Hcy in the study group was 24.28±4.01μmol/L,which was significantly higher than the 10.31±1.45μmol/L of the control group.The level of CysC in the study group was 1.45±0.21 mg/L was significantly higher than 0.80±0.16 mg/L in the control group,and the vWF level in the study group was 152.88±15.73%,which was significantly higher than 92.31±16.21%in the another group.Multivariate regression analysis manifested that Hcy,CysC and vWF can be used as independent predictors,which are significantly related to the patient’s disease degree,and have a certain predictive effect on diagnosis and prognosis.Conclusion:Ultrasound has high sensitivity and specificity in the diagnosis of diabetic cerebrovascular disease,and has important diagnostic significance.Hcy,CysC and vWF can be used as independent predictors of diabetic cerebrovascular disease,which are significantly related to the disease degree of patients.