踝臂指数及经皮氧分压预测2型糖尿病心脑血管事件
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摘要
目的探讨踝臂指数(ABI)及经皮氧分压(TcPO2)预测2型糖尿病(T2DM)心脑血管事件风险的价值。方法采用前瞻性随访研究,选取海南医学院第二附属医院2015年1月—2016年6月住院患者中排除已并发心脑血管疾病及其他严重疾病的T2DM患者198例,测定ABI及TcPO2并院外随访,终点为主要不良心血管事件(MACE)。采用Cox比例风险模型探索T2DM患者MACE的风险因子;采用生存曲线分析ABI与TcPO2预测T2DM心脑血管事件风险的价值。结果失访18例,共180例患者纳入分析,平均随访(19.5±4.7)个月,其中28例(15.6%)T2DM患者发生了MACE。生存分析曲线表明,ABI≤0.9组发生MACE(P<0.01);TcPO2正常组及异常组的生存曲线比较差异无统计学意义(P>0.05);Cox回归分析表明ABI可作为T2DM心脑血管事件的风险预测因子(RR=0.142,P<0.01),且这种预测价值在校正年龄、吸烟史、糖尿病病程、收缩压、总胆固醇(TC)后仍然存在(RR=0.176,P<0.05);TcPO2与T2DM患者MACE无显著相关性(RR=1.544,P>0.05)。结论 ABI可作为2型糖尿病心脑血管事件的风险预测指标,尚无法证明TcPO2对心脑血管事件具备预测价值。
Objective To explore the potential value of ankle brachial index(ABI) and transcutaneous oxygen pressure(TcPO2) as predictor of cardiovascular events in type 2 diabetes mellitus. Methods This was a prospective follow-up study.Hospitalized patients in The Second Affiliated Hospital of Hainan Medical University from January 2015 to June 2016 were selected, if they were excluded with cardiovascular and other severe diseases, and 198 type 2 diabetic patients were included.ABI and TcPO2 of these patients were measured and followed upout of hospital. The end of follow up was major adverse cardiovascular events(MACE). Cox proportional hazard model was used to explore risk factors of MACE in type 2 diabetes and survival curves to analyze ABI and TcPO2 as predictors of cardiovascular events in type 2 diabetes. Results Eighteen patients with lost visits were excluded, and a total of 180 patients were included in the analysis.After a mean follow-up period of(19.5±4.7) months, 28 patients(15.6%) had MACE. Survival analysis suggested that the ABI≤0.9 group had higher incidence of MACE compared with the ABI>0.9 group(66.7% vs 19.8%, P< 0.01), while groups between normal and abnormal TcPO2 had no significant difference in MACE(P>0.05). Cox regression analysis showed that ABI had predictive value for the occurrence of MACE(RR=0.142, P<0.01), when adjusted for age, smoking history, diabetes duration, systolic blood pressure,and total cholesterol(TC) level, this value still existed(RR=0.176, P<0.05). There was no significant correlation between TcPO2 and MACE in T2 DM patients(RR=1.544,P>0.05). Conclusions ABI can be a predictor of MACE in T2 DM patients, while TcPO2 could not be proved to have predictive value for cardiovascular events.
Objective To explore the potential value of ankle brachial index(ABI) and transcutaneous oxygen pressure(TcPO2) as predictor of cardiovascular events in type 2 diabetes mellitus. Methods This was a prospective follow-up study.Hospitalized patients in The Second Affiliated Hospital of Hainan Medical University from January 2015 to June 2016 were selected, if they were excluded with cardiovascular and other severe diseases, and 198 type 2 diabetic patients were included.ABI and TcPO2 of these patients were measured and followed upout of hospital. The end of follow up was major adverse cardiovascular events(MACE). Cox proportional hazard model was used to explore risk factors of MACE in type 2 diabetes and survival curves to analyze ABI and TcPO2 as predictors of cardiovascular events in type 2 diabetes. Results Eighteen patients with lost visits were excluded, and a total of 180 patients were included in the analysis.After a mean follow-up period of(19.5±4.7) months, 28 patients(15.6%) had MACE. Survival analysis suggested that the ABI≤0.9 group had higher incidence of MACE compared with the ABI>0.9 group(66.7% vs 19.8%, P< 0.01), while groups between normal and abnormal TcPO2 had no significant difference in MACE(P>0.05). Cox regression analysis showed that ABI had predictive value for the occurrence of MACE(RR=0.142, P<0.01), when adjusted for age, smoking history, diabetes duration, systolic blood pressure,and total cholesterol(TC) level, this value still existed(RR=0.176, P<0.05). There was no significant correlation between TcPO2 and MACE in T2 DM patients(RR=1.544,P>0.05). Conclusions ABI can be a predictor of MACE in T2 DM patients, while TcPO2 could not be proved to have predictive value for cardiovascular events.
引文
[1]李梦娟,李素梅,汝燕,等.经皮氧分压联合踝臂指数在2型糖尿病合并下肢动脉疾病中的临床应用[J].国际病理科学与临床杂志,2011,31(5):381-384.
[2]李鹏,杨兵全,孙子林.经皮氧分压评价糖尿病下肢动脉病变的应用进展[J].中国糖尿病杂志,2015,23(3):284-286.
[3]姚兰.2型糖尿病患者踝臂指数与心脑血管事件的关系[J].中国实用医药,2010,5(3):15-16.
[4]汪迟凤,肖丽华,罗震.踝臂指数与2型糖尿病合并冠心病的相关性的研究[J].中国当代医药,2012,19(21):71-72.
[5]LI J,LUO Y,XU Y,et al.Risk factors of peripheral arterial disease and relationship between low ankle-brachial index and mortality from all-cause and cardiovascular disease in Chinese patients with type 2 diabetes[J].Circ J,2007,71(3):377-381.
[6]YOKOYAMA H,SONE H,HONJO J,et al.Relationship between a low ankle brachial index and all-cause death and cardiovascular eventsin subjects with and without diabetes[J].J Atheroscler Thromb,2014,21(6):574-581.
[7]GAZZARUSO C,COPPOLA A,FALCONE C,et al.Transcutaneous oxygen tension as a potential predictor of cardiovascular events in type 2 diabetes:comparison with ankle-brachial index[J].Diabetes Care,2013,36(6):1720-1725.
[8]POTIER L,ABI KHALIL C,MOHAMMEDI K,et al.Use and utility of ankle brachial index in patients with diabetes[J].EuropeanJournalofVascularand Endovascular Surgery,2011,41(1):110-116.
[9]HATMI Z N,DABIRAN S,KASHANI A S,et al.Ankle-brachial index as a prognostic factor and screening tool in coronary artery disease:does it work?[J].J Tehran Heart Cent,2014,9(4):174-178.
[10]徐玉珠,刘俊艳.踝臂指数与心脑血管事件的相关性[J].临床荟萃,2014,29(5):599-601.
[11]MILIONIS H,VEMMOU A,NTAIOS G,et al.Ankle-brachial index Long-term outcome after first-ever ischaemic stroke[J].Eur J Neurol,2013,20(11):1471-1478.
[12]O'HAREA M,KATZ R,SHLIPAKM G,et al.Mortality and cardiovascular risk across the ankle-arm index spectrum[J].Circulation,2006,113(3):388-393.
[13]KOJIMA I,NINOMIYA T,JUNH T,et al.A low ankle brachial index is associated with an increased risk of cardiovascular disease:the hisayama study[J].JournalofAtherosclerosis and Thrombosis,2014,21(9):966-973.
[14]颜雯,陈雪云,张伟勇,等.2型糖尿病患者踝臂指数与冠状动脉病变程度的相关性研究[J].中国当代医药,2015,22(18):21-23,26.
[15]PARDO M,ALCARAZ M,BERNALF L,et al.Transcutaneous oxygen tension measurements following peripheral transluminal angioplasty procedure has more specificity and sensitivity than ankle brachial index[J].theBritishJournal of Radiology,2015,88(1046):20140571.
[16]HUANG K,MA Y J,WANG J,et al.The correlation between transcutaneous oxygen tension and microvascular complications in type 2diabetic patients[J].Journal of Diabetes and its Complications,2017,31(5):886-890.
[2]李鹏,杨兵全,孙子林.经皮氧分压评价糖尿病下肢动脉病变的应用进展[J].中国糖尿病杂志,2015,23(3):284-286.
[3]姚兰.2型糖尿病患者踝臂指数与心脑血管事件的关系[J].中国实用医药,2010,5(3):15-16.
[4]汪迟凤,肖丽华,罗震.踝臂指数与2型糖尿病合并冠心病的相关性的研究[J].中国当代医药,2012,19(21):71-72.
[5]LI J,LUO Y,XU Y,et al.Risk factors of peripheral arterial disease and relationship between low ankle-brachial index and mortality from all-cause and cardiovascular disease in Chinese patients with type 2 diabetes[J].Circ J,2007,71(3):377-381.
[6]YOKOYAMA H,SONE H,HONJO J,et al.Relationship between a low ankle brachial index and all-cause death and cardiovascular eventsin subjects with and without diabetes[J].J Atheroscler Thromb,2014,21(6):574-581.
[7]GAZZARUSO C,COPPOLA A,FALCONE C,et al.Transcutaneous oxygen tension as a potential predictor of cardiovascular events in type 2 diabetes:comparison with ankle-brachial index[J].Diabetes Care,2013,36(6):1720-1725.
[8]POTIER L,ABI KHALIL C,MOHAMMEDI K,et al.Use and utility of ankle brachial index in patients with diabetes[J].EuropeanJournalofVascularand Endovascular Surgery,2011,41(1):110-116.
[9]HATMI Z N,DABIRAN S,KASHANI A S,et al.Ankle-brachial index as a prognostic factor and screening tool in coronary artery disease:does it work?[J].J Tehran Heart Cent,2014,9(4):174-178.
[10]徐玉珠,刘俊艳.踝臂指数与心脑血管事件的相关性[J].临床荟萃,2014,29(5):599-601.
[11]MILIONIS H,VEMMOU A,NTAIOS G,et al.Ankle-brachial index Long-term outcome after first-ever ischaemic stroke[J].Eur J Neurol,2013,20(11):1471-1478.
[12]O'HAREA M,KATZ R,SHLIPAKM G,et al.Mortality and cardiovascular risk across the ankle-arm index spectrum[J].Circulation,2006,113(3):388-393.
[13]KOJIMA I,NINOMIYA T,JUNH T,et al.A low ankle brachial index is associated with an increased risk of cardiovascular disease:the hisayama study[J].JournalofAtherosclerosis and Thrombosis,2014,21(9):966-973.
[14]颜雯,陈雪云,张伟勇,等.2型糖尿病患者踝臂指数与冠状动脉病变程度的相关性研究[J].中国当代医药,2015,22(18):21-23,26.
[15]PARDO M,ALCARAZ M,BERNALF L,et al.Transcutaneous oxygen tension measurements following peripheral transluminal angioplasty procedure has more specificity and sensitivity than ankle brachial index[J].theBritishJournal of Radiology,2015,88(1046):20140571.
[16]HUANG K,MA Y J,WANG J,et al.The correlation between transcutaneous oxygen tension and microvascular complications in type 2diabetic patients[J].Journal of Diabetes and its Complications,2017,31(5):886-890.
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