踝臂指数、臂踝脉搏波传导速度及血清Meprin-α水平对2型糖尿病合并冠心病的诊断价值研究

摘要

目的：探讨踝臂指数（ABI）、臂踝脉搏波传导速度（baPWV）及血清Meprin-α水平对2型糖尿病合并冠心病的诊断价值。方法选取2010—2013年中国人民解放军第三军医大学西南医院老年病科收治的单纯2型糖尿病患者92例（T2DM 组），单纯冠心病患者153例（CHD 组），2型糖尿病合并冠心病患者68例（T2DM-CHD组）；另选取同期体检健康者150例作为对照组。检测各组受试者 ABI、baPWV 及血清Meprin-α水平，并分析 ABI、baPWV 及血清Meprin-α水平对冠心病及2型糖尿病合并冠心病的诊断价值。结果 T2DM 组和T2DM-CHD组患者 ABI 低于对照组（P ﹤0.05）；T2DM 组、CHD 组及T2DM-CHD组患者 baPWV 高于对照组，T2DM-CHD组患者 baPWV 高于 CHD 组（P ﹤0.05）；T2DM 组、CHD 组及 T2DM-CHD 组患者血清 Meprin-α水平高于对照组，T2DM 组和 T2DM-CHD 组患者血清Meprin-α水平高于 CHD 组（P ﹤0.05）。受试者工作特征曲线（ ROC）曲线显示，ABI 对冠心病无诊断价值（ P ﹥0.05），baPWV 对冠心病的诊断价值较高（ AUC ＝0.973），血清Meprin-α水平对冠心病的诊断价值为中等（ AUC ＝0.720）。baPWV 对2型糖尿病合并冠心病的诊断价值较高（AUC ＝0.940），当 baPWV≥1936 cm/ s 时其诊断2型糖尿病合并冠心病的灵敏度为82.4%、特异度为96.7%；血清Meprin-α水平对2型糖尿病合并冠心病的诊断价值为中等（AUC ＝0.875），当血清Meprin-α水平≥2314 ng/ L 时其诊断2型糖尿病合并冠心病的灵敏度为80.9%、特异度为92.4%。以冠状动脉造影作为诊断冠心病的金标准，baPWV≥1936 cm/ s 联合血清Meprin-α水平≥2314 ng/ L 对2型糖尿病合并冠心病的诊断符合率为98.1%。结论 ABI 与冠状动脉病变无明显相关性，baPWV 对2型糖尿病合并冠心病的诊断价值较高，血清Meprin-α水平对2型糖尿病合并冠心病的诊断价值为中等，baPWV 联合血清Meprin-α水平对2型糖尿病合并冠心病的诊断价值更高。%Objective To analyze the diagnostic value of ABI,baPWV and serum Meprin-α level in diagnosis of type 2 diabetes mellitus complicated with coronary heart disease. Methods From 2010 to 2013 in the Department of Geriatrics, Southwest Hospital of the Third Military Medical University of Chinese People's Liberation Army,92 patients with isolated type 2 diabetes mellitus were served as A group,153 patients with isolated coronary heart disease were served as B group,68 type 2 diabetes mellitus patients complicated with coronary heart disease were served as C group,150 healthy cases were served as D group. ABI,baPWV and serum Meprin-α level were detected,and their diagnostic value on coronary heart disease and type 2 diabetes mellitus complicated with coronary heart disease was analyzed,respestively. Results ABI of A group,C group was statistically significantly lower than that of D group,respectively( P ﹤ 0. 05);baPWV of A group,B group,C group was statistically significantly higher than that of D group,respectively,and baPWV of C group was statistically significantly higher than that of B group(P ﹤ 0. 05);serum Meprin-α level of A group,B group,C group was statistically significantly higher than that of D group,respectively,and serum Meprin-α level of A group,C group was statistically significantly higher than that of B group,respectively(P ﹤ 0. 05).ROC curve showed that,ABI had no diagnostic value on coronary heart disease(P ﹥ 0. 05), while baPWV had relatively high diagnostic value on coronary heart disease(AUC = 0. 973),serum Meprin-α level had medium diagnostic value on coronary heart disease( AUC = 0. 720). baPWV had relatively high diagnostic value on type 2 diabetes mellitus complicated with coronary heart disease(AUC = 0. 940),when it was equal or over 1 936 cm/ s,the sensitivity was 82. 4% ,the specificity was 96. 7% ;serum Meprin-α level had medium diagnostic value on type 2 diabetes mellitus complicated with coronary heart disease(AUC = 0. 875),when it was equal or over 2 314 ng/ L,the sensitivity was 80. 9% ,the specificity was 92. 4% . Take coronary angiography as the gold standard for coronary heart disease,the diagnostic accordance rate of combination of baPWV equal or over 1 936 cm/ s and serum Meprin-α level equal or over 2 314 ng/ L was 98. 1% on type 2 diabetes mellitus complicated with coronary heart disease. Conclusion ABI is not significantly correlated with coronary artery lesion,baPWV has relatively high diagnostic value on type 2 diabetes mellitus complicated with coronary heart disease,and serum Meprin-α level has medium diagnostic value on type 2 diabetes mellitus complicated with coronary heart disease, combination of baPWV and serum Meprin-α level has higher diagnostic value on type 2 diabetes mellitus complicated with coronary heart disease.