冠心病危险指数对老年2型糖尿病患者颈动脉内膜增厚的风险评估

  目的  探讨冠心病危险指数(coronary risk index，CRI)对老年2型糖尿病(T2DM)患者发生颈动脉硬化疾病(CAD)的预测价值，为临床筛查CAD风险提供参考。  方法  选取2019年9—12月期间于合肥市第一人民医院及合肥市滨湖医院就诊的老年T2DM患者156例，以颈动脉内膜增厚和斑块形成作为分组依据将患者分为非颈动脉硬化组(55例)、颈动脉内膜增厚组(52例)和颈动脉斑块形成组(49例)，记录各组临床资料。使用SPSS 25.0统计学软件对数据进行分析。  结果  Spearman相关性分析显示:冠心病危险指数与老年T2DM患者颈动脉内膜厚度呈正相关(r=0.158, P=0.049)。以CRI取值的四分位数作为临界值，将冠心病危险指数分为Q1~Q4四个区间，与颈动脉内膜厚度做logistic回归分析，结果显示:在Q1~Q3区间段，随着CRI升高，患者发生颈动脉内膜增厚的风险升高(OR值分别为1.000、1.677、5.333)，在Q4段，CRI升高对患者发生颈动脉内膜增厚的风险性略有降低(OR=2.970)；CRI升高对老年2型糖尿病患者颈动脉内膜增厚的风险预测具有倒U型关系。  结论  当患者CRI在3.59~4.14范围内，医护人员应观察患者是否存在微血管病变的临床征象；若CRI长期处于过高水平(CRI≥4.15)，应警惕发生隐匿性血管微病变。临床中可将总胆固醇与高密度脂蛋白胆固醇比值纳入老年T2DM患者CAD筛查中，综合评判患者发生CAD的风险。 

Risk assessment of carotid intimal thickening in elderly patients with type 2 diabetes by coronary risk index:Inverted U curve

Objective To explore the predictive value of coronary risk index(CRI)for carotid atherosclerosis(CAD)in elderly patients with type 2 diabetes mellitus(T2 DM)and provide references for clinical screening of risk for CAD.Methods A total of 156 elderly patients with T2 DM who were treated in two third-class hospitals in Hefei from September 2019 to December 2019 were selected.On the basis of carotid artery intimal thickening and plaque formation,the patients were divided into non-carotid arteriosclerosis groups:Control group(55 cases),carotid artery intimal thickening group(52 cases)and carotid artery plaque formation group(49 cases).The clinical data of each group were recorded.Data were analysed using SPSS 25.0.Results Spearman correlation analysis revealed that the coronary heart disease risk index was positively correlated with carotid artery intima thickness in the elderly patients with T2 DM(r=0.158,P=0.049).With the quartile of CRI as the critical value,the coronary heart disease risk index was divided into four intervals(Q1-Q4),and carotid artery intima thickness was analysed via logistic regression analysis.In the Q1-Q3 interval,as the risk of carotid artery intimal thickening increased as CRI increased(OR values for Q1,Q2 and Q3 were 1.000,1.677 and 5.333,respectively).In the Q4 interval,increased CRI the risk of carotid artery intimal thickening slightly decreased as CRI increased(OR=2.970).The increase in ratio displayed an inverted U-shaped relationship with the risk of carotid artery intimal thickening in the elderly patients with T2 DM.Conclusion When CRI ranges from 3.59 to 4.14,medical staff should carefully observe if patients are showing clinical signs of microvascular diseases;if the CRI is at an excessively high level for a long time(CRI≥4.15),the staff should be alerted to the occurrence of occult microvascular diseases.Clinically,the Total Cholesterol/High-Density Lipoprotein Cholesterol(TC/HDL-C)ratio can be included in screening for CAD among elderly patients with T2 DM to comprehensively evaluate the risk of CAD in these patients.