糖尿病围术期心血管事件相关因素分析及hs-CRP对其预测准确性的临床价值

Correlation factors analysis of perioperative cardiovascular events in patients with diabetes and clinical value of hs-CRP in its prediction

目的分析糖尿病围术期心血管事件(PCE)的相关因素,并探讨超敏C反应蛋白(hs-CRP)水平预测糖尿病围术期心血管事件准确性的临床价值。方法选取我院内分泌科2012年2月至2014年2月间择期行非心脏手术的糖尿病患者共380例,根据血浆hs-CRP水平将患者分为低浓度组(hs-CRP<1.1 mg/L)47例、中浓度组(hs-CRP 1.1~3.8 mg/L)62例和高浓度组(hs-CRP 3.8~10.0 mg/L)271例。将与PCE发生可能相关的术前因素应用Logistic逐步回归分析,并采用准确性检验(ROC曲线)分析危险因素预测围术期PCE发生的准确性。结果低浓度组患者PCE的发生率为0。中浓度组患者中,严重心律失常8例,发生率为12.9%;心肌缺血12例,发生率为19.4%。高浓度组患者中,严重心律失常22例,发生率为8.11%;心肌缺血68例,发生率为25.1%,严重心率失常合并心肌缺血10例,发生率为3.7%。Logistic逐步回归分析结果显示,心力衰竭分级、年龄、糖化血红蛋白(Hb Alc)水平、超声心动图、hs-CRP是糖尿病患者围术期PCE发生的危险因素(P<0.05);心力衰竭分级、Hb Alc水平、超声心动图和hs-CRP的围术期PCE的ROC曲线下面积分别为0.386、0.360、0.732、0.827。结论糖尿病患者PCE主要相关因素为hs-CRP、Hb Alc水平、心力衰竭分级、超声心动图,hs-CRP预测PCE的发生率具有一定的准确性。

Objective To analyze the correlation factors of the diabetes perioperative cardiovascular events(PCE) in patients with diabetes, and study the clinical value of high-sensitivity C-reactive protein(hs-CRP) levels for accuracy of predicating perioperative cardiovascular events. Methods A total of 380 patients with diabetes scheduled for non-cardiac surgery, who admitted to Department of Endocrine of our hospital from February 2012 to February 2014,were selected and divided into the low concentration group(hs-CRP<1.1 mg/L, n=47), the median concentration group(hs-CRP for 1.1-3.8 mg/L, n=62) and the high concentration group(hs-CRP for 3.8-10.0 mg/L, n=271). Logistic stepwise regression analysis was used to analyze the perioperative risk factors of PCE, and the predictive accuracy of PCE was evaluated by the ROC curve. Results The incidence of PCE in low concentration group was 0. In the median concentration group, there were 8 cases of serious arrhythmias(12.9%) and 12 cases of myocardial ischemia(19.4%). In the high concentrations group, there were 22 cases of serious arrhythmia(8.11%), 68 cases of myocardial ischemia(25.1%)and 10 cases of severe arrhythmias and myocardial ischemia(3.7%). Logistic stepwise regression analysis showed that heart failure classification, age, glycosylated hemoglobin(Hb Alc) levels, echocardiography and hs-CRP were risk factors of PCE in perioperative period(P<0.05). The area under the Receiver Operating Characteristic curve(ROC) curve of heart failure classification, glycosylated hemoglobin(Hb Alc) levels, echocardiography and hs-CRPI for PCE in perioperative period were respectively 0.386, 0.360, 0.732 and 0.827. Conclusion The main factors associated with PCE in patients with diabetes are hs-CRP, Hb Alc levels, heart failure classification and echocardiography, and hs-CRP has certain accuracy for predicting the incidence of PCE.