论文部分内容阅读
目的:研究建立2型糖尿病(DM)患者合并肾动脉粥样硬化性狭窄(ARAS)的预测模型。方法:经肾动脉造影证实的2型糖尿病ARAS患者129例和无ARAS者122例。对两组年龄、DM病程等指标进行统计学分析。结果:最终进入模型的ARAS独立预测因子是年龄(≥65岁)(OR=42.66,P<0.01),加速性高血压(OR=24.78,P<0.01),DM病程≥5年(OR=4.76,P<0.05),颈动脉内膜中层厚度(IMT)≥1 mm(OR=3.41,P<0.01)及Ccr≥90 mL/min(OR=0.91,P<0.01)。预测ARAS的最佳概率值是0.54(敏感度86.0%,特异度93.4%)。Logistic回归方程ROC曲线下面积为0.868(95%CI=0.816～0.92,P<0.01),Cox and Snell决定系数R2=0.586。结论:年龄≥65岁、AH、DM病程≥5年、颈动脉IMT≥1 mm、Ccr≥90 mL/min是DM患者并发ARAS的独立预测因子,该预测模型可以对2型糖尿病患者进行肾动脉狭窄的风险预测,不仅有助于提高彩超及有创检查的诊断阳性率,而且可以减少不必要的漏诊以提高治疗的成本效益。
Objective: To study the establishment of a predictive model of renal atherosclerotic stenosis (ARAS) in patients with type 2 diabetes mellitus (DM). Methods: 129 ARAS patients with type 2 diabetes confirmed by renal artery angiography and 122 without ARAS were enrolled. Two groups of age, DM duration and other indicators for statistical analysis. Results: ARAS-independent predictors of final entry into the model were age (≥65 years) (OR = 42.66, P <0.01), accelerated hypertension (OR = 24.78, , Carotid intima - media thickness (IMT) ≥1 mm (OR = 3.41, P <0.01) and Ccr ≥90 mL / min (OR = 0.91, P <0.01). The best predictive value of ARAS was 0.54 (sensitivity 86.0%, specificity 93.4%). The area under the ROC curve of Logistic regression equation was 0.868 (95% CI = 0.816-0.92, P <0.01), and Cox and Snell coefficient of determination R2 = 0.586. CONCLUSIONS: Age ≥65 years, duration of AH and DM ≥5 years, carotid IMT ≥1 mm, and Ccr ≥90 mL / min are independent predictors of ARAS complicated with DM. This predictive model can be used for type 2 diabetic patients with renal artery Narrow risk prediction, not only helps to improve the diagnostic positive rate of color Doppler ultrasound and invasive examination, but also can reduce unnecessary missed diagnosis to improve the cost-effectiveness of treatment.