脂联素、直接胆红素及甘油三酯对2型糖尿病患者大血管病变的诊断价值

Diagnostic value of adiponectin, direct bilirubin, and triglyceride for macro-vascular complications disease in patients with type 2 diabetes

摘要:

目的 探讨脂联素（APN）、直接胆红素（DB）、甘油三酯（TG）及三者联合对2型糖尿病（T2DM）患者大血管病变的诊断价值。方法 选取120例T2DM患者，根据是否合并大血管病变将其分为T2DM组（62例）和T2DM+大血管病变组（58例）。比较两组的临床资料；采用非条件多因素逐步Logistic回归分析T2DM患者合并大血管病变的风险因素；绘制受试者工作特征（ROC）曲线评估APN、DB、TG及三者联合对T2DM患者合并大血管病变的诊断效能。结果 非条件多因素逐步Logistic回归分析结果显示，HbA1c ［O^R=24.096（95% CI：6.419，90.453）］、LDL-C ［O^R=13.118（95% CI：2.202，78.134）］和TG ［O^R=7.019（95% CI：2.414，20.407）］是T2DM患者合并大血管病变的危险因素（P <0.05）；HDL-C ［O^R=0.000（95% CI：0.000，0.011）］、APN ［O^R=0.504（95% CI：0.313，0.809）］和DB ［O^R=0.694（95% CI：0.581，0.829）］是T2DM患者合并大血管病变的保护因素（P <0.05）。ROC曲线分析结果显示，当APN ≤ 5.870 nmol/mL时，诊断T2DM患者合并大血管病变的曲线下面积（AUC）为0.718，敏感性为70.7%（95% CI：0.571，0.815），特异性为61.3%（95% CI：0.480，0.713）；当DB ≤ 14.205 mol/L时，AUC为0.772，敏感性为74.1%（95% CI：0.607，0.844），特异性为71.0%（95% CI：0.579，0.814）；当TG ≥ 1.955 mol/L时，AUC为0.735，敏感性为72.4%（95% CI：0.589，0.830），特异性为69.4%（95% CI：0.562，0.801）；三者联合诊断的AUC为0.881，敏感性为84.5%（95% CI：0.721，0.922），特异性为77.4%（95% CI：0.647，0.867）。结论 APN、DB、TG可用于T2DM患者合并大血管病变的辅助诊断，且三者联合可进一步提升诊断效能。

Abstract:

Objective To explore the diagnostic value of adiponectin (APN), direct bilirubin (DB), triglyceride (TG) and their combination for macro-vascular complications (MVC) in patients with type 2 diabetes (T2DM).Methods One hundred and twenty patients with T2DM were divided into T2DM group (n = 62) and T2DM + MVC group (n = 58) according to whether they were complicated with macrovascular diseases. Univariate and multivariate logistic regression were used to analyze the risk factors of T2DM patients with MVC. The diagnostic efficacy of APN, DB, TG, and their combination on T2DM patients with MVC was evaluated by plotting ROC curve.Results The results of stepwise logistic regression analysis showed that HbA1 level [O^R = 24.096 (95% CI: 6.419, 90.453) ], LDL-C level [O^R = 13.118 (95% CI: 2.202, 78.134) ] and TG level [O^R = 7.019 (95% CI: 2.414, 20.407) ] were the risk factors of T2DM patients with MVC (P <0 .05); HDL-C level [O^R = 0.000 (95% CI: 0.000, 0.011) ], APN level [O^R = 0.504 ( 95% CI: 0.313, 0.809) ], and DB level [O^R = 0.694 (95% CI: 0.581, 0.829) ] were protective factors for T2DM patients with MVC (P < 0.05). ROC analysis showed that when APN ≤ 5.870 nmol/mL, the area under the curve (AUC) of T2DM patients with MVC was 0.718, the sensitivity was 70.7% (95% CI: 0.571, 0.815), and the specificity was 61.3% (95% CI: 0.480, 0.713); When DB ≤ 14.205 mol/L, AUC is 0.772, sensitivity is 74.1% (95% CI: 0.607, 0.844), specificity is 71.0% (95CI: 0.579, 0.814); When TG ≥ 1.955 mol/L, AUC is 0.735, sensitivity is 72.4% (95% CI: 0.589, 0.830), specificity is 69.4% (95% CI: 0.562, 0.801); The AUC of the combined diagnosis was 0.881, the sensitivity was 84.5% (95% CI: 0.721, 0.922), and the specificity was 77.4% (95% CI: 0.647, 0.867).Conclusion APN, DB, and TG can be used for the auxiliary diagnosis of T2DM patients with MVC, and the combination of the three can further improve the diagnostic efficiency.