摘要
目的:探讨糖尿病对外周动脉疾病(Peripheral arterial disease,PAD)患者下肢动脉钙化的影响,并分析糖尿病及下肢动脉钙化程度与PAD患者总生存时间(Overall survival,OS)的相关性。方法:回顾性收集2011年1月—2018年12月期间于中国医科大学附属盛京医院介入病房就诊的存在下肢缺血症状的PAD患者。利用半自动软件在CT平扫图像上测量下肢动脉钙化积分(Lower limb arterial calcification score,LLACS),利用倾向性评分匹配(Propensity score matching,PSM)方法分析糖尿病与非糖尿病PAD患者下肢各节段动脉钙化积分差异。采用Cox风险比例模型分析糖尿病、下肢动脉钙化程度对PAD患者OS的影响。应用ROC曲线评估年龄及下肢动脉钙化积分预测PAD患者全因死亡事件的能力。结果:共纳入172例患者(糖尿病91例,非糖尿病81例)。糖尿病组的总LLACS(P=0.036)、股腘动脉钙化积分(P=0.003)及膝下动脉钙化积分(P=0.037)均明显高于非糖尿病组;将动脉硬化的常见危险因素进行PSM后得到54例糖尿病患者和54例非糖尿病患者,糖尿病组的股腘动脉钙化积分(P=0.013)及膝下动脉钙化积分(P=0.029)仍显著高于非糖尿病组。多因素分析显示年龄(P<0.001)及股腘动脉钙化积分(P=0.020)是PAD患者OS的独立影响因素,而糖尿病与PAD患者的OS无关(P=0.515)。ROC曲线分析显示年龄与股腘动脉钙化积分联合对PAD患者全因死亡的发生有较高的预测价值(AUC=0.735,95%CI 0.633~0.837,P<0.001)。结论:合并糖尿病的PAD患者的股腘动脉及膝下动脉钙化更严重。股腘动脉钙化积分与PAD患者的OS具有相关性。
Objective: To investigate the effect of diabetes on lower limb arterial calcification in patients with peripheral arterial disease(PAD), and to analyze the correlation between diabetes, the degree of lower limb arterial calcification and the overall survival(OS) of PAD patients. Methods: PAD patients with lower limb ischemia in the intervention ward of Shengjing Hospital of China Medical University from January 2011 to December 2018 were collected retrospectively. Lower limb arterial calcification score(LLACS) was measured on CT plain scan images by semi-automatic software. Propensity score matching(PSM)was used to analyze the difference of arterial calcification score in each segment of lower limb between diabetic and non-diabetic PAD patients. The Cox risk radio model was used to analyze the effect of diabetes and the degree of lower limb arterial calcification on OS in patients with PAD. ROC curve was used to evaluate the ability of age and LLACS to predict all-cause death in PAD patients. Results: A total of 172 patients(91 diabetics and 81 non diabetics) were included. The total LLACS(P=0.036), the femoropopliteal artery calcification score(P=0.003) and the infrapopliteal artery calcification score(P=0.037) in the diabetes group were significantly higher than those in the non diabetes group. After PSM the common risk factors of arteriosclerosis, 54 diabetic patients and 54 non-diabetic patients were obtained, the femoropopliteal artery calcification score(P=0.013) and the infrapopliteal artery calcification score(P=0.029) in the diabetes group were still significantly higher than those in the non diabetes group. Multivariate analysis showed that age(P<0.001) and the femoropopliteal artery calcification score(P=0.020) were independent influencing factor of OS in patients, while diabetes was not related to OS in patients(P=0.515). ROC curve analysis showed that the combination of age and the femoropopliteal artery calcification score had high predictive value for all-cause death in patients with PAD(AUC =0.735
作者
薛新月
畅智慧
刘兆玉
XUE Xin-yue;CHANG Zhi-hui;LIU Zhao-yu(Department of Radiology,Shengjing Hospital of China Medical University,Shenyang 110004,China)
出处
《中国临床医学影像杂志》
CAS
CSCD
2022年第6期404-408,413,共6页
Journal of China Clinic Medical Imaging
基金
辽宁省博士科研启动基金(2019-BS-286)。
关键词
外周动脉疾病
糖尿病
体层摄影术
螺旋计算机
Peripheral Arterial Disease
Diabetes Mellitus
Tomography,Spiral Computed
