本文關(guān)鍵詞： 2型糖尿病 冠狀動(dòng)脈粥樣硬化性心臟病 股動(dòng)脈內(nèi)膜中層厚度 踝臂指數(shù)　出處：《蚌埠醫(yī)學(xué)院》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究通過觀察單純2型糖尿病(T2DM)組、T2DM合并冠狀動(dòng)脈粥樣硬化性心臟病(CAD)組生化指標(biāo)、股動(dòng)脈內(nèi)中膜厚度(FAIMT)、踝臂指數(shù)(ABI)的變化,比較組間各指標(biāo)的差別,評(píng)價(jià)FAIMT、ABI對(duì)T2DM患者CAD的預(yù)測(cè)價(jià)值。方法:選取2014.10-2015.11我院內(nèi)分泌科住院的T2DM患者150例為研究對(duì)象,分為非冠狀動(dòng)脈粥樣硬化性心臟病組(NCAD組)、CAD組,CAD組再根據(jù)冠狀動(dòng)脈病變支數(shù)分為單支病變組(CAD1組)、多支病變組(CAD2組),對(duì)其臨床資料、生化指標(biāo)、FAIMT、ABI、CAD的發(fā)生及冠狀動(dòng)脈病變情況進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:HDL-C在NCAD組與CAD2組之間有統(tǒng)計(jì)學(xué)差異(P0.05),其余生化指標(biāo)組間無統(tǒng)計(jì)學(xué)差異。NCAD組與CAD組、NCAD組與CAD2組相比較,ABI和FAIMT值均有顯著性差異(P0.01);而CAD1組與CAD2組相比,僅有FAIMT值有統(tǒng)計(jì)學(xué)差異(P0.01),ABI并無顯著性差異。多因素回歸分析結(jié)果表明,ABI(β=-0.626,P0.05)、FAIMT(β=1.309,P0.01)是冠心病發(fā)生的獨(dú)立危險(xiǎn)因素。ROC曲線分析發(fā)現(xiàn)FAIMT為0.875mm時(shí)對(duì)CAD的預(yù)測(cè)價(jià)值最高,靈敏度為79%,特異度為92%,曲線下面積(AUC)為0.891,P0.01;FAIMT預(yù)測(cè)冠狀動(dòng)脈嚴(yán)重病變的曲線下面積為0.818,P0.01,FAIMT值為1.025mm時(shí)對(duì)冠狀動(dòng)脈嚴(yán)重病變的預(yù)測(cè)價(jià)值最高,靈敏度為60%,特異度為92%;ABI值為0.99時(shí),對(duì)CAD的陰性預(yù)測(cè)價(jià)值最高,AUC為0.789,P0.01,靈敏度為76%,特異度為72%,但是對(duì)CAD的陽(yáng)性預(yù)測(cè)價(jià)值不高(AUC=0.2110.5)。結(jié)論:T2DM合并CAD組中FAIMT顯著高于NCAD組,ABI低于NCAD組,并且FAIMT在CAD2組中高于CAD1組,兩組間差異有統(tǒng)計(jì)學(xué)意義,對(duì)冠狀動(dòng)脈粥樣硬化病變程度的評(píng)估有較好的提示作用。FAIMT、ABI與CAD有顯著的相關(guān)性,均是CAD的獨(dú)立危險(xiǎn)因素,同時(shí)兩者對(duì)CAD的診斷有一定的預(yù)測(cè)價(jià)值。
[Abstract]:Objective: to observe the biochemical indexes and medial thickness of femoral artery (IMT) of T2DM with coronary atherosclerotic heart disease (CAD) in type 2 diabetes mellitus (T2DM) group. The change of ankle brachial index (ABI), compare the difference of each index between groups, and evaluate the FAIMT. The predictive value of ABI for CAD in patients with T2DM. Methods: 150 cases of T2DM patients hospitalized in Endocrinology Department of our hospital from October to November 2014.were selected as study subjects. The patients were divided into non-coronary atherosclerotic heart disease group (NCAD group) and CAD group (CAD group was divided into single vessel lesion group (CAD1 group) according to the number of coronary artery disease branches). The clinical data and biochemical index of CAD2 group were compared with that of FAIMT ABI. The incidence of CAD and coronary artery disease were statistically analyzed. Results there was significant difference between NCAD group and CAD2 group (P 0.05). There was no statistical difference in the other biochemical indexes between the two groups. There was significant difference in ABI and FAIMT between NCAD group and CAD group compared with CAD2 group (P 0.01). However, there was no significant difference in FAIMT between CAD1 group and CAD2 group. The results of multivariate regression analysis showed that there was no significant difference in FAIMT value between CAD1 group and CAD2 group. ABI (尾 -0.626 P0.05) FAIMT (尾 1. 309). P0.01) was an independent risk factor for coronary heart disease. ROC curve analysis showed that when FAIMT was 0.875 mm, the predictive value of CAD was the highest, and the sensitivity was 79%. The specificity was 92 and the area under the curve was 0.891p0.01; When the area under the curve of FAIMT for predicting severe coronary artery disease was 0.818 渭 m P0.01FIMT was 1.025mm, it had the highest predictive value for severe coronary artery disease. The sensitivity was 60 and the specificity was 92. When ABI value was 0.99, the negative predictive value of CAD was the highest (0.789% P0.01), the sensitivity was 76% and the specificity was 72%. However, the positive predictive value of CAD was not high. Conclusion the FAIMT in CAD group with T2DM is significantly higher than that in NCAD group and NCAD group. And the FAIMT in CAD2 group is higher than that in CAD1 group, the difference between the two groups is statistically significant, which has a better role in the evaluation of coronary atherosclerosis. Both ABI and CAD are independent risk factors for CAD, and both have predictive value in the diagnosis of CAD.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R587.1;R541.4

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