2型糖尿病患者冠状动脉病变严重程度的相关因素

Factors associated with the severity of coronary artery disease in type 2 diabetes mellitus patients

目的对2型糖尿病(T2DM)患者冠状动脉病变严重程度的相关因素进行分析,以期为其风险评估提供参考。方法回顾性分析2019年1月至2023年5月济南市人民医院收治的322例T2DM合并冠状动脉疾病患者的临床资料,根据Gensini评分分为轻度组(≤54分,n=177)和中重度组(>54分,n=145),对比两组患者的年龄、性别、血液指标等临床资料,采用logistic回归分析和最小绝对收缩和选择算子(LASSO)回归法筛选与T2DM患者冠状动脉病变严重程度的相关性因素,构建预测模型,绘制模型校准曲线和受试者工作特征曲线(ROC)并计算曲线下面积(AUC)评价其准确性。结果中重度组患者年龄及总胆固醇、空腹血糖、残余胆固醇、血清脂蛋白a[Lp(a)]水平均高于轻度组患者(P<0.05)。对于T2DM患者中重度冠状动脉病变,多因素logistic回归分析结果显示年龄(Z=3.251,P=0.001)、残余胆固醇(Z=2.564,P=0.010)和血清Lp(a)(Z=7.989,P<0.001)水平是其独立危险因素(P<0.05),LASSO回归结果显示,年龄、残余胆固醇和血清Lp(a)水平是其独立预测因素(P<0.05),由上述因素构建的列线图预测模型准确性较好(AUC=0.826)。结论年龄、残余胆固醇和血清Lp(a)水平可有效预测T2DM患者冠状动脉病变的严重程度,且准确性较好。

Objective To analyze the factors related to the severity of coronary artery disease(CAD)in type 2 diabetes mellitus(T2DM)patients,with the aim of providing a reference for the risk assessment of them.Methods Clinical data of 322 T2DM patients combined with CAD admitted to Jinan City People's Hospital from January 2019 to May 2023 were retrospectively analyzed.They were divided into the mild group(Gensini score≤54,n=177)and the moderate to severe group(Gensini score>54,n=145)based on the Gensini score.The clinical data of age,gender,and blood indexes between the two groups were compared.Least absolute shrinkage and selection operator(LASSO)and logistic regression analysis were used to screen for factors correlated with the severity of CAD in T2DM patients.The prediction model was established,the model calibration curve and the receiver operating characteristic curve(ROC)were drawn,and the area under the curve(AUC)was calculated to evaluate its accuracy.Results Age,total cholesterol,fasting blood glucose,remnant cholesterol and lipoprotein(a)levels were higher in the moderate to severe CAD in the mild group(P<0.05).For patients with moderate to severe coronary artery lesions in T2DM,the multivariate logistic regression analysis showed that age,residual cholesterol and serum lipoprotein(a)levels were independent risk factors(P<0.05).LASSO regression showed age(Z=3.251,P=0.001),residual cholesterol(Z=2.565,P=0.010)and serum lipoprotein(a)levels(Z=7.989,P<0.001)were independent predictor of T2MD patients with moderate to serve CAD,and the column chart prediction model constructed from the above factors had good accuracy(AUC=0.826).Conclusion Age,remnant cholesterol and lipoprotein(a)levels can effectively predict the severity of CAD in T2DM patients,and have good accuracy.