ABI和1C风险评分对2型糖尿病下肢动脉病变的预测价值比较

发布时间：2018-06-11 23:36

本文选题：2型糖尿病 + 下肢血管病变　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:踝肱指数(ABI)是筛查糖尿病下肢动脉疾病(LEAD)的一项简便、无创、广泛使用的筛查手段。但由于需要固定的检查设备,ABI筛查在初级医疗机构的应用受到一定限制,并且对于血管局限性狭窄或广泛血管钙化的患者,ABI的检查结果有时并不能反应真实的血管状态。间歇性跛行(IC)风险评分是来自于Framingham心脏研究的一项评分,以年龄、性别、血浆胆固醇水平、高血压、吸烟史、糖尿病、冠心病七个因素为预测因子进行系统评分,以预测未来4年间歇性跛行的发生概率,该评分也被国外一些机构用来对LEAD进行评估。本研究的主要目是1、了解2型糖尿病患者发生LEAD的危险因素并在ABI筛查基础上探索更有效、便捷的筛查公式。2、评估ABI和IC风险分数用于糖尿病LEAD预测价值。3、比较ABI和IC风险分数对LEAD的预测价值。方法:研究对象来自南昌大学第一附属医院内分泌科门诊以及住院部符合纳入标准的2型糖尿病患者,采集患者就诊时的病历资料,包括:年龄、性别、糖尿病病程、吸烟史、高血压病史、冠心病病史,检测空腹血糖、血脂四项,计算出每位患者的IC风险分数。另外,对每位患者进行踝肱指数(ABI)测定以及下肢血管彩色多普勒超声检查。以下肢血管彩超结果作为临床终点事件,分别以ABI值和IC风险评分与下肢彩超结果进行Spearman相关分析,并采用ROC分析对IC以及ABI对LEAD的预测价值进行评价。结果:研究共纳入252例患者,其中左下肢ABI与左下肢彩超结果同时收集到的病例数为236例,左下肢ABI与左下肢血管彩超异常呈负相关(P0.01,r=-0.186);右下肢ABI与右下肢彩超结果同时收集到的病例数为238例,右下肢ABI与右下肢血管彩超异常呈负相关(P0.01,r=-0.199)。IC与LEAD: IC与左下肢彩超结果同时收集到的病例数为249例,IC值与左下肢血管彩超异常呈正相关(r=0.250, P0.01);右下肢IC与右下肢彩超结果同时收集到的病例数为250例,IC值与右下肢血管彩超异常呈正相关(r=0.245, P0.01)。对IC和ABI的预测价值进行ROC分析,结果无论是左侧还是右侧的预测结果,IC的AUC值均高于ABI。结论:下肢ABI与下肢血管彩超异常呈负相关(P0.01) , IC风险分数与下肢血管彩超异常呈正相关(r=0.250,P0.01),ABI与LEAD风险呈负相关,IC风险分数与LEAD风险呈正相关;IC评分对LEAD的预测高于ABI。
[Abstract]:Objective: malleolus brachial index (ABI) is a simple, non-invasive and widely used method for screening diabetic lower extremity arterial diseases. However, the application of ABI screening in primary medical institutions is limited due to the need for fixed equipment, and the results of ABI in patients with localized stenosis or extensive calcification of blood vessels sometimes do not reflect the true blood vessel status. The intermittent claudication risk score, a score from the Fraingham Heart study, was systematically rated as a predictor of seven factors: age, sex, plasma cholesterol levels, hypertension, smoking history, diabetes, and coronary heart disease. In order to predict the probability of intermittent claudication in the next four years, the score has also been used by some foreign institutions to evaluate read. The main purpose of this study is to understand the risk factors of Lead in type 2 diabetic patients and to explore the effectiveness of ABI screening. To evaluate the predictive value of ABI and IC risk scores in diabetes mellitus read, the predictive value of ABI and IC risk scores to read was compared. Methods: patients with type 2 diabetes were collected from the Department of Endocrinology, Department of Endocrinology, first affiliated Hospital of Nanchang University and inpatient department. The medical records of the patients were collected, including age, sex, course of diabetes, history of smoking. The history of hypertension, coronary heart disease, fasting blood glucose and blood lipids were measured to calculate the IC risk score of each patient. In addition, the ankle-brachial index (ABI) and lower extremity vascular color Doppler ultrasound were measured in each patient. Using the results of lower extremity color Doppler ultrasound as the clinical endpoint, Spearman correlation analysis was carried out between the ABI value and IC risk score, and the predictive value of IC and ABI for read was evaluated by ROC analysis. Results: a total of 252 patients were included in the study, among whom 236 cases were collected simultaneously by left lower limb ABI and left lower extremity color Doppler ultrasound. There was a negative correlation between left lower extremity ABI and left lower extremity vascular color Doppler ultrasonography (P0.01r-0.186), and 238 cases of right lower extremity ABI and right lower extremity color Doppler ultrasound were collected simultaneously. There was a negative correlation between the right lower extremity ABI and the right lower extremity vascular color Doppler ultrasound abnormality (P0.01r-0.199.IC and LEAD: IC and left lower extremity color Doppler sonography results: 249 cases were positive correlation between IC value and left lower extremity vascular color Doppler ultrasound abnormality, P0.01C, right lower extremity IC and right lower extremity color ultrasound. Results there was a positive correlation between the IC value of 250 cases and the abnormal color Doppler ultrasound of the right lower extremity (0.245, P 0.01). The predicted values of IC and ABI were analyzed by ROC. The results showed that the AUC value of IC was higher than that of ABII. Conclusion: lower extremity ABI is negatively correlated with lower extremity vascular color Doppler ultrasound abnormality (P 0.01), and IC risk score is positively correlated with lower extremity vascular color Doppler ultrasound abnormality. There is a negative correlation between ABI and read risk.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2

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