主动脉瓣环内径诊断2型糖尿病合并冠心病的效能研究

Performance of aortic annulus diameter in diagnosis of T2DM with concomitant coronary heart disease

目的探讨超声心动图(ultrasound cardiogram,UCG)常见指标主动脉瓣环内径诊断2型糖尿病(type 2 diabetes mellitus,T2DM)合并冠心病(coronary heart disease,CHD)的效能。方法采用病例-对照研究设计方案,纳入2022年10月1日至2023年10月31日徐州医科大学附属医院心血管内科收治入院并行冠状动脉造影的患者。训练集440例,其中确诊T2DM合并CHD(T2DM-CHD)患者217例,单纯T2DM患者223例。验证集按照7∶3比例抽取187例,其中T2DM-CHD患者91例,单纯T2DM患者96例。同步采集患者一般临床资料和UCG各项指标,统计分析各项UCG指标与T2DM合并CHD的相关性,根据受试者操作曲线下面积(area under the subject curve,AUC)大小选择最佳预测指标,并进一步确定用于诊断的切点并验证诊断的准确性。结果所有UCG指标中只有主动脉窦内径和主动脉瓣环内径两项指标组间具有显著性差异(P<0.05)。同时,此两项指标与两组的诊断分型显著相关(P<0.05)。主动脉瓣环内径对诊断分型的AUC最大为0.920(P<0.01),敏感性(0.819)和特异性(0.843)最佳,切点为23.00 mm,此切点验证诊断的准确率为90.37%。结论主动脉瓣环内径可作为一个识别T2DM-CHD患者的关键预测指标,当T2DM患者心脏主动脉瓣环内径<23.00 mm时合并CHD的可能性大。

Objective To investigate the performance of a common echocardiographic(ECG)indicator,aortic annulus diameter,in the diagnosis of type 2 diabetes mellitus(T2DM)complicated with coronary heart disease(CHD).Methods A cross-sectional study was conducted on the patients undergoing coronary angiography in Department of Cardiovascular Medicine of Affiliated Hospital of Xuzhou Medical University from October 1,2022 to October 31,2023.A total of 440 patients were included into a training set,including 217 with confirmed T2DM combined with CHD(T2DM-CHD group)and 223 patients with simple T2DM(control group).In a ratio of 7∶3,another 187 patients were selected and assigned into a validation group,including 91 T2DM-CHD patients and 96 T2DM patients.Their general clinical data and ECG indicators were collected,and the relationships of ECG indicators and coexistence of T2DM-CHD were analyzed.Receiver operating characteristic curve(ROC)was plotted to identify the best predictor for the coexistence with area under the curve(AUC),and the cutoff values and their accuracies in diagnosis were further determined and verified.Results Among all ECG indicators,only aortic sinus and aortic annulus diameter showed statistical differences between the T2DM-CHD group and the control group(P<0.05).Significant correlations were observed between the above 2 indicators and the diagnostic types of the 2 groups(P<0.05).The AUC value of aortic annulus diameter in predicting diagnostic types was 0.920(P<0.01),with a sensitivity of 0.819 and a specificity of 0.843,and the cutoff value was 23.00 mm,which had an accuracy of 90.37%.Conclusion Aortic annulus diameter is a pivotal predictor for identifying T2DM-CHD patients.The T2DM patients with aortic ring diameter<23.00 mm are more common with concomitant CHD.