冠状动脉CTA联合血清HCY、Cys-C、ApoB/ApoA1比值对2型糖尿病患者合并冠状动脉病变的诊断价值

摘要 目的：探究冠状动脉CT血管造影（CTA）联合血清同型半胱氨酸（HCY）、胱抑素C（Cys-C）、载脂蛋白B/载脂蛋白A1（ApoB/ApoA1）比值对2型糖尿病（T2DM）患者合并冠状动脉病变的诊断价值。方法：回顾性选取2018年8月到2021年8月间我院收治的358例T2DM患者，均行常规生化指标、CTA检查、冠状动脉造影（CAG）检查，根据CAG检查结果为金标准将T2DM患者分为未合并冠脉病变组（190例）和合并冠脉病变组（168例），比较两组血清HCY、Cys-C、ApoB/ApoA1比值，分析CTA与CAG诊断冠脉狭窄结果的一致性，应用受试者工作特征（ROC）曲线评估冠状动脉CTA联合血清HCY、Cys-C、ApoB/ApoA1比值对T2DM合并冠状动脉病变的诊断价值。结果：与未合并冠脉病变组比较，合并冠脉病变组血清HCY、Cys-C、ApoB、ApoB/ApoA1比值水平明显更高（P＜0.05），ApoA1明显更低（P＜0.05）。以CAG为金标准，CTA诊断冠脉狭窄程度与CAG一致性较高（Kappa值0.748）。ROC曲线评估冠状动脉CTA诊断T2DM合并冠脉病变的AUC、灵敏度、特异度、准确度依次为0.802、74.40%、83.71%、79.11%。三项血清指标联合AUC、准确度显著优于单一指标（P＜0.05）。冠状动脉CTA联合血清HCY、Cys-C、ApoB/ApoA1比值诊断T2DM合并冠脉病变的价值显著优于各项指标单一诊断或三项血清指标联合诊断（P＜0.05）。结论：冠状动脉CTA联合血清HCY、Cys-C、ApoB/ApoA1比值诊断T2DM患者合并冠状动脉病变的价值较高，相较各项指标单一应用而言更具优势。

Diagnostic Value of Coronary Artery CTA Combined with Serum HCY, Cys-C, ApoB/ApoA1 Ratio in Type 2 Diabetes Mellitus Patients with Coronary Artery Disease

ABSTRACT Objective: To explore the diagnostic value of coronary artery CT angiography (CTA) combined with serum homocysteine (HCY), cystatin C (Cys-C), apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio in type 2 diabetes mellitus (T2DM) patients with coronary artery disease. Methods: 358 patients with T2DM who were admitted to our hospital from August 2018 to August 2021 were retrospectively selected, all of whom underwent routine biochemical indicators, CTA examination and coronary angiography (CAG) examination. According to the CAG examination results as the gold standard, patients with T2DM were divided into the non combined with coronary artery disease group (190 cases) and combined with coronary artery disease group (168 cases). The serum HCY, Cys-C, ApoB/ApoA1 ratio in the two groups were compared, and the consistency of the results of CTA and CAG in diagnosing coronary stenosis was analyzed, The diagnostic value of coronary artery CTA combined with serum HCY, Cys-C, ApoB/ApoA1 ratio in patients with T2DM with coronary artery disease was evaluated by receiver operating characteristic (ROC) curve. Results: Compared with the non combined with coronary artery disease group, the levels of serum HCY, Cys-C, ApoB, ApoB/ApoA1 ratio in the combined with coronary artery disease group were significantly higher (P<0.05), and ApoA1 was significantly lower (P<0.05). With CAG as the gold standard, the degree of coronary stenosis diagnosed by CTA was consistent with CAG (Kappa value 0.748). ROC curve was used to evaluate the AUC, sensitivity, specificity and accuracy of coronary artery CTA in diagnosing T2DM with coronary artery disease were 0.802, 74.40%, 83.71% and 79.11%, respectively. The accuracy of three serum indicators combined with AUC was significantly better than that of a single indicator (P<0.05). The value of coronary artery CTA combined with serum HCY, Cys-C and ApoB/ApoA1 ratio in the diagnosis of T2DM combined with coronary artery disease was significantly better than that of single or combined with three serum indicators (P<0.05). Conclusion: Coronary artery CTA combined with serum HCY, Cys-C, ApoB/ApoA1 ratio has higher value in the diagnosis of patients with T2DM with coronary artery disease, and which has more advantages than the single application of all indicators.