摘要
Abstract
Objective To investigate the risk factors for the development of lower extremity atherosclerosis(LEAD)in elderly patients with type 2 diabetes mellitus(T2DM)and to construct a preliminary prediction model for the development of LEAD in elderly patients with T2DM based on the glycated hemoglobin variabil-ity index(HGI).Methods A total of 213 elderly patients with T2DM admitted to the hospital from January 2021 to July 2023 were retrospectively selected as the training set.In addition,102 elderly patients with T2DM admitted to the same hospital during the same period were selected as the validation set.The training set was divided into LEAD group and non-LEAD group according to whether LEAD occurred.The clinical data of pa-tients were collected.Receiver operating characteristic(ROC)curve was used to analyze the optimal cut-off value of HGI for predicting the risk of LEAD in elderly patients with T2DM.Multivariate Logistic regression was used to analyze the influencing factors of LEAD in elderly patients with T2DM.Results A total of 315 elderly patients with T2DM were included in the training set and validation set,of which 66 cases had LEAD in the training set,with an incidence of 20.95％.There were 51 patients in LEAD group and 162 patients in non-LEAD group.There were significant differences in age,proportion of patients with hypertension,duration of diabetes,low-density lipoprotein cholesterol(LDL-C)level and HGI between the two groups(P＜0.05).The results of ROC curve analysis showed that the area under the curve of HGI for predicting the risk of LEAD in elderly T2DM patients in the training set was 0.846(95％CI:0.816-0.877).When the optimal cut-off value of HGI was-0.015,the Youden index was the maximum 0.774,the sensitivity was 0.811 and the specificity was 0.873.Multivariate Logistic regression analysis showed that age ≥65 years,hypertension,prolonged duration of diabetes,LDL-C≥4.1 mmol/L and HGI≥-0.015％were independent risk factors for LEAD in elderly T2DM patients(P＜0.05).The model validation results showed that the consistency index of the training set and the validation set were 0.877(95％CI:0.832-0.862)and 0.794(95％CI:0.771-0.817)respectively.The calibration curves of the training set and the validation set were close to the ideal curve,and the net benefit value of the model was positive within the prediction range of 0.00 to 0.82(exclu-ding endpoints).Conclusion HGI has a high predictive value for the risk of LEAD in elderly patients with T2DM,and the nomogram model based on HGI can effectively predict the risk of LEAD in elderly patients with T2DM.关键词
糖化血红蛋白变异指数/老年2型糖尿病/下肢动脉粥样硬化/危险因素/列线图Key words
glycated hemoglobin variation index/type 2 diabetes mellitus in the elderly/lower extrem-ity atherosclerosis/risk factor/nomogram分类
临床医学
