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1、军医进修学院学报2009Apr,30(2)·155·AcadJChinesePLAPostgradMedSch2型糖尿病颈动脉狭窄筛查张丹丹,母义明,安力春,王良宸,关小宏,窦京涛,陆菊明,潘长玉(解放军总医院内分泌科,北京100853)[摘要]目的:通过分析1005例颈动脉狭窄大于50%病变在2型糖尿病(T2DM)患者中的发病率及其独立危险因素,探索T2DM人群中颈动脉狭窄的筛查策略。方法:对1005例T2DM患者进行颈动脉超声筛查,记录各项动脉粥样硬化的危险因素,代入Logistic回归方程,得出颈动脉狭窄>50%的独立危险因素,以限定外周动脉狭窄的高危人群
2、,提高筛查效率。结果:颈动脉狭窄(CS)>50%的发病率为3.3%。CS>50%的独立危险因素是:男性(OR∶4.0;CI∶1.3-12.1)、纤维蛋白原≥4g/L(OR∶4.5;CI∶1.7-12.1)。不具备这两个危险因素对CS>50%的阴性预测率为98.6%。结论:T2DM患者中大规模筛查颈动脉狭窄的意义有限,建议在男性及纤维蛋白原≥4g/L的糖尿病患者中筛查CS>50%。[关键词]颈动脉狭窄;外周血管疾病;糖尿病;超声检查,多普勒,彩色;多相筛查[中图分类号]R587.1[文献标识码]A[文章编号]100521139(2009)0220155203Scr
3、eeningstrategyforcarotidandperipheralarterystenosisinpatientswithtype2diabetesZHANGDan2dan,MUYi2ming,ANLi2chun,WANGLiang2chen,GUANXiao2hong,DOUJing2tao,LUJu2ming,PANChang2yu(DepartmentofEndocrinology,ChinesePLAGeneralHospital,Beijing100853,China)Correspondingauthor:MUYi2ming.Email:mu
4、yiming@301hospital.com.cn[ABSTRACT]Objective:Tostudytheprevalenceofcarotidarterystenosis>50%inadiabeticpopulationandtodeterminethepredictivefactorsforanopticalscreeningstrategy.Methods:Atotalof1005type2diabeticpatientsunderwentphysicalex2aminationandultrasoundscanningforcarotidarteri
5、es.Riskfactorsforatherosclerosiswerealsorecorded.Logisticregressiona2nalysisshowedthatthepredictivefactorsforcarotidstenosis(CS)couldincreasetheefficiencyofscreening.Results:Theprev2alenceofCS>50%was3.5%.TheindependentriskfactorsforCS>50%weremalegender(OR:4.0;CI:1.3-12.1)andfibrinoge
6、n≥4g/L(OR:4.5;CI:1.7-12.1).Ifthetworiskfactorswereexcluded,thenegativepredictivevalueforCS>50%was98.6%.Conclusion:OurdatasuggestalowprevalenceofCS>50%indiabeticpatients.TheprobabilityoffindingCS>50%isthehighestamongmaleandfibrinogen≥4g/Lpatients.Screeningforcarotidandperipheralartery
7、stenosisindiabeticpa2tientswithouttheseriskfactorsseemsinappropriateduetoaverylowprobabilityofCS>50%.[KEYWORDS]carotidstenosis;peripheralvasculardiseases;diabetesmellitus;ultrasonography,doppler,color;multiphasicscreening[3]2型糖尿病是动脉粥样硬化的独立危险因筛查有中枢神经系统症状或颈动脉杂音的患者。[1]素。动脉粥样硬化在糖尿病前期即可发生
8、,可缓另外有研究显示对无
