摘要目的 评价高敏C反应蛋白(hs-CRP)预测糖尿病患者围术期心血管事件(CVA)发生的准确性.方法 合并2型糖尿病的择期非心脏手术患者91例,根据血浆hs-CRP浓度分为低浓度组(hs-CRP＜1.0 mg/L,n=9)、中浓度组(hs-CRP 1.0～2.9 mg/L,n=16)及高浓度组(ha-CRP 3.0～10.0mg/L,n=66).记录与围术期CVA发生可能有关的术前因素.采用Spearman秩相关分析与围术期CVA发生相关的危险因素,对危险因素进一步纳入logistic回归分析,筛选高度相关的危险因素.采用受试者工作特征(ROC)曲线下面积分析危险因素预测围术期CVA发生的准确性.结果 低浓度组、中浓度组及高浓度组围术期CVA的发生率分别为0、31%和35%.Spearman秩相关分析结果表明,ECG、NYHA分级、年龄、超声心动图、hs-CRP及ASA分级是与围术期CVA发生相关的危险因素(P＜0.05或0.01).logistic回归分析结果表明,ECG、NYHA分级和年龄是与围术期CVA发生高度相关的危险因素(P＜0.05或0.01).ECG、NYHA分级、年龄、hs-CRP预测围术期发生CVA的ROC曲线下面积分别为0.855、0.755、0.702和0.605.结论 血hs-CRP浓度预测糖尿病患者围术期CVA发生的准确性低于ECG、NYHA分级和年龄.

abstractsObjective To evaluate the accuracy of high-aensitivity C-reactive protein (hs-CRP) in the prediction of perioperative cardiovascular accidents (CVAS) in patients with diabetes mellitus. Methods Ninetyone type 2 diabetic patients undergoing elective non-cardiac surgery were divided into 3 groups according to their blood concentrations of hs-CRP: low-concentration group ＜ 1.0 mg/L ( group Ⅰ , n = 9); median-concentration group 1.0-2.9 mg/L (group Ⅱ ,n= 16) and high-concentration group 3.0-10.0 mg/L (group Ⅲ ,n =66). Risk factors for perioperative CVA were analyzed using Spearman rank correlation analysis. Various risk factors including sex, age, ASA physical status, BMI, NYHA claasification, smoking history ,preoperative ECG changes, duration,treatment and complications of diabetes mellitus, hypertension and blood lipids were correlated with perioperative CVA. The risk factors of which P values were less than 0.05 would enter the binary logistic regression analysis to stratify CVA-related risk factors. Area under the ROC curve was used to analyze the accuracy of the risk factors in prediction of perioperative CVA. Results The incidences of perioperative CVAs were 0, 31% and 35 % in Ⅰ ,Ⅱ and Ⅲ groups respectively. It was determined by Spearman rank correlation analysis that preoperative ECG,NYHA classification, age, preoperative cardiovascular color doppler ultrasound, blood hs-CRP concentration and ASA classification of physical status were important risk factors ( P ＜ 0.05 or 0.01 ). Binary logistic regression .malysis indicated that preoperative ECG, NYHA classification and age were highly related to perioperative CVA (P ＜0.05 or 0.01).The area under ROC curve of preoperative ECG, NYHA classification, age and blood hsCRP concentration was 0.855, 0.755, 0.702 and 0.605 respectively. Conclusion The accuracy of blood concentration of hs-CRP in prediction of perioperative CVA in patients with diabetes mellitus is lower than that of the preoperative ECG, NYHA classification or age.