血栓弹力图α角、k值对糖尿病肾脏疾病患者心血管不良事件的预测价值

The predictive value of angleαand k value of thrombismogram in the occurrence of major adverse cardiovascular events in patients with diabetic kidney disease

目的评估血栓弹力图α角、k值对DKD患者主要心血管不良事件(MACE)的预测价值。方法选取2017年6月至2019年2月于福建医科大学附属第二医院内分泌科住院治疗的T2DM患者192例,分为单纯T2DM组(T2DM,n=95)及T2DM合并DKD组(DKD,n=97);另选取同期本院健康体检者80名为正常对照(NC)组。测定α角、k值、纤维蛋白原(Fib),随访2年内心血管事件(MACE)发生情况。将DKD组按是否发生MACEs分为MACE亚组和未发生MACE亚组,多因素Logistic回归分析MACE的影响因素,受试者工作特征(ROC)曲线分析α角、k值对MACE的预测价值。结果与T2DM、NC组比较,DKD组α角、Fib升高(P<0.05),k值降低(P<0.05)。Spearman相关分析显示,DKD与α角、Fib呈正相关(P<0.01),与k值呈负相关(P<0.01)。多因素Logistic分析结果显示,吸烟史、α角升高、k值降低是MACE的影响因素。α角、k值对MACE预测价值分别为ROC曲线下面积(AUC)=0.813,95%CI 0.721~0.885;AUC=0.805,95%CI 0.712~0.878。结论血栓弹力图α角、k值有望作为评估DKD患者MACE的预测指标。

Objectives To evaluate the angleαand k value of thrombelastogram in predicting the risk of major adverse cardiovascular events(MACE)in patients with diabetic kidney disease(DKD).Methods 192 patients with type 2 diabetes mellitus(T2DM)were selected,including 97 with DKD and 95with simple T2DM.80 healthy subjects were set as normal control(NC)group.Angleα,k value and Fib were measured respectively.The incidence of MACE in the DKD patients was followed up for 2 years.Results Angleαand Fib were higher while k value was lower in DKD group than those in T2DM and NC groups(P<0.05).Angleαand Fib were positively correlated with DKD(P<0.01).k value was negatively correlated with DKD(P<0.01).The history of smoking,increased angleαand decreased k value were independent factors for the occurrence of MACE within 2 years after the onset of DKD.The ROC curve indicated that the predictive value of angleαand k value on MACE were AUC=0.813,95%CI 0.721~0.885 and AUC=0.805,95%CI 0.712~0.878.Conclusion Angleαand k value may be predictors for assessing the risk of MACE in DKD patients.