初诊2型糖尿病合并颈动脉斑块患者颈动脉斑块灰阶中位数值预测脑梗死的临床研究

Clinical study on the prediction of cerebral infarction by the median value of carotid plaque grayscale in newly diagnosed type 2 diabetes patients with carotid plaque

目的 探讨三维超声颈动脉斑块灰阶中位数值(Grayscale median, GSM)对初诊2型糖尿病(Type 2 diabetes mellitus, T2DM)合并颈动脉斑块患者发生脑梗死的预测价值。方法 回顾性分析2017年6月-2020年6月在本院住院治疗的初诊T2DM合并颈动脉斑块患者,根据随访中是否发生脑梗死分为脑梗死组(n=28)和非脑梗死组(n=199);收集首次住院的临床资料及三维超声颈动脉斑块指标灰阶中位数值(Grayscale median, GSM)、斑块体积(Plaque volume, PV)、斑块厚度(Plaque thickness, PT);比较2组临床资料及超声指标水平的差异,进一步采用logistic回归分析初诊T2DM患者发生脑梗死的影响因素,采用受试者工作特征(Receiver operating characteristic,ROC)曲线分析不同指标对初诊T2DM患者发生脑梗死的预测效能。结果 脑梗死组合并冠心病的比例(35.71%vs 19.09%)及空腹血糖[(7.37±1.32)vs(6.82±0.85) mmol/L]、餐后2 h血糖[(13.16±3.52)vs(11.97±2.14) mmol/L]、糖化血红蛋白(Glycosylated Hemoglobin, Type A1C,HbA1c)[(7.03±0.98)vs(6.55±0.33)%]、总胆固醇[(5.98±1.13)vs(5.41±0.94) mmol/L]、低密度脂蛋白胆固醇(Low density lipoprotein cholesterol, LDLC)[(3.42±0.65)vs(3.05±0.40) mmol/L]、尿酸[(360.01±76.87)vs(320.15±80.55) mmol/L]水平高于非脑梗死组(P<0.05),颈动脉斑块的GSM[(35.24±6.92)vs(41.93±11.82)]均低于非脑梗死组(P<0.05),颈动脉斑块PT,PV与非脑梗死组比较无明显差异(P>0.05)。LDLC,HbA1c、颈动脉斑块GSM是初诊T2DM患者发生脑梗死的影响因素,比值比分别为36.073、4.205、0.852(P<0.05)且四项指标单独或联合均对初诊T2DM患者发生脑梗死具有预测价值,联合指标的预测效能优于单一指标。结论 初诊T2DM患者颈动脉斑块GSM降低与脑梗死的发病有关,GSM联合实验室指标LDL-C,HbA1c能够进行脑梗死发病的预测。

Objective To study the predictive value of three-dimensional carotid plaques gray scale median(GSM) on cerebral infarction of newly diagnosed type 2 diabetes mellitus(T2 DM)patients complicated with carotid plaque.Methods The patients with newly diagnosed T2 DM complicated with carotid plaque in our hospital from June 2017 to June 2020 were retrospectively analyzed. According to whether cerebral infarction occurred during the follow-up, they were divided into the cerebral infarction group(n=28) and the non-cerebral infarction group(n=199). The clinical data of the first hospitalization and three-dimensional ultrasound indexes, including GSM, plaque volume(PV), and plaque thickness(PT) were collected. The differences in clinical data and ultrasound indexes between the two groups were compared. Logistic regression was used to analyze the influencing factors of cerebral infarction in newly diagnosed T2 DM patients. ROC curve was used to analyze the predictive effect of different indicators on cerebral infarction in newly diagnosed T2 DM patients.Results The proportion of coronary heart disease history(35.71% vs 19.09%) and the levels of fasting blood glucose(7.37±1.32 vs 6.82±0.85 mmol/L), 2 h postprandial blood glucose(13.16±3.52 vs 11.97±2.14 mmol/L), glycosylated hemoglobin(HbA1 c)(7.03±0.98 vs 6.55±0.33) %, total cholesterol(5.98±1.13 vs 5.41±0.94 mmol/L), low-density lipoprotein cholesterol(LDLC)(3.42±0.65 vs 3.05±0.40 mmol/L), uric acid(360.01±76.87 vs 320.15±80.55 mmol/L) were higher than those of non-cerebral infarction group. The GSM of carotid plaque(35.24±6.92 vs 41.93±11.82) was lower than that of non-cerebral infarction group(P<0.05). PT and PV are similar among different groups(P>0.05). LDL-C, HbA1 c, and carotid plaque GSM were the influencing factors of cerebral infarction in newly diagnosed T2 DM patients. The OR were 36.073, 4.205, and 0.852, respectively(P<0.05). These four indexes alone or combined had predictive value for cerebral infarction in newly diagnosed T2 DM patients. The predictive effect of the combined index was better than that of a single index.Conclusion The decrease of carotid plaque GSM level of newly diagnosed T2 DM patients is related to the incidence of cerebral infarction. GSM levels combined with laboratory indexessuch as LDL-C and HbA1 c can predict the incidence of cerebral infarction.