2型糖尿病合并肥胖患者经格列美脲治疗并发MACE的影响因素分析

Analysis of Risk Factors for MACE in Type 2 Diabetic Patients with Obesity after Glimepiride Therapy

目的:探讨2型糖尿病(T2DM)合并肥胖患者经格列美脲治疗后并发主要心血管不良事件(MACE)的独立因素,并建立临床预测模型进行验证。方法:回顾性分析2020年4月至2022年4月于我院就诊的206例2型糖尿病合并肥胖患者临床资料,随访2年,根据患者有无并发MACE分为两组,即发生组(n=25,并发MACE),未发生组(n=181,未并发MACE),比较两组一般资料后,经二元Logistic回归模型分析影响患者并发MACE的独立因素,再利用模型验证。结果:经二元Logistic回归分析,年龄>60岁(OR=3.532)、病程>5年(OR=3.513)、BMI>30.0 kg·m^(-2)(OR=3.190)、低血糖(OR=2.902)、治疗依从性差(OR=0.295)、服药剂量>2 mg·d^(-1)(OR=3.253)是影响T2DM合并肥胖患者发生MACE的独立因素(P<0.05)。将独立因素构建列线图,校准曲线的C-index为0.99,真实值和预测值吻合度绝对误差为0.016,预测模型AUC为0.850,95%CI 0.785~0.915。结论:T2DM合并肥胖患者经格列美脲治疗后并发MACE会受到服药剂量、治疗依从性、低血糖、病程、年龄影响,因此需针对风险因子加以干预,从而降低MACE发生率。

Objective:To investigate the independent factors associated with major adverse cardiovascular events(MACE)in type 2 diabetes mellitus(T2DM)patients with obesity after glimepiride therapy and establish a clinical prediction model for validation.Meth-ods:A total of 206 T2DM patients with obesity were collected from April 2020 to April 2022 with 2 years of follow-up.The patients were divided into two groups according to the presence of MACE,namely the occurrence group(n=25,with MACE)and nonoccurrence group(n=181,without MACE).After comparing the general data of the two groups,binary Logistic regression analysis was performed to ana‐lyze the independent factors affecting the occurrence of MACE,and then model validation was vsed.Results:After binary Logistic regres‐sion analysis,age>60 years old(OR=3.532),disease duration>5 years(OR=3.513),BMI>30.0 kg·m^(-2)(OR=3.190),hypoglyce‐mia(OR=2.902),poor treatment compliance(OR=0.295),and dose>2 mg·d^(-1)(OR=3.253)were independent factors affecting the occurrence of MACE in T2DM patients with obesity(P<0.05).The nomogram was constructed from independent factors,the C-index of the calibration curve was 0.99,the absolute error of agreement between the true and predicted values was 0.016,the predic‐tion model AUC was 0.850,and the 95%CI was 0.785~0.915.Conclusion:In T2DM patients with obesity,the occurrence of MACE after glimepiride therapy is affected by the dosage,treatment compliance,hypoglycemia,disease duration,and age,so the interventions targeting risk factors are needed to reduce the incidence of MACE.