| Objective:To evaluate the diagnostic effects of carotid ultrasound and serum hypersensitive C-reactive protein (hs-CRP) test in acute myocardial infarction (AMI) in patients with type 2 Diabetes mellitus(DM).Methods:A total of 473 patients from Liao cheng people’s hospital between January 2013 and October 2014 were enrolled in this study, in which 143 patients were type 2 DM complicating AMI group,180 patients were type 2 diabetes alone group and 150 healthy subjects were healthy control group. Carotid ultrasound was used to measure the carotid artery-intima-media thickness (IMT) and examine carotid artery plaque formation conditions on all subjects, and immune turbidimetric method was used to detect the hs-CRP levels of the objects. Regarding 1 Specificity as the abscissa and sensitivity as the ordinate, the receiver-operating characteristic (ROC) curve was plotted to calculate the sensitivity, specificity and area under curve of carotid artery ultrasound, hs-CRP detection and a combination in the diagnosis of DM complicating AMI. Moreover, IMT, plaques conditions and the serum levels were compared among three groups. The sensitivity, specificity and the area under ROC curve of three methods were also compared. SPSS 19.0 statistical software was used for processing analysis.Results:1. There were significant differences in IMT among three groups. (F= 249.34, P<0.05). The number of carotid plaques in type 2 DM complicating AMI group was significantly higher than that in healthy control group and type 2 diabetes alone group (F= 83.16, P< 0.05), in addition, the ratio of unstable plaque in type 2 DM complicating AMI group was also significantly higher than that in the other two groups (P< 0.05). Meanwhile the characteristic of plaque composition showed significant differences among three groups. Furthermore, the number of carotid plaques and unstable plaques proportion in type 2 diabetes alone group was obviously higher than that in healthy control group (P< 0.05).2. The hs-CRP levels of type 2 DM complicating AMI group were significantly higher than that of type 2 diabetes alone group and healthy control group (P< 0.05), meanwhile the hs-CRP protein content of type 2 diabetic alone was also higher than that of healthy control group (P<0.05).3. Compared with patients with stable plaque, patients with thickening membrane in the carotid artery and patients with normal carotid artery, there was a higher serum hs-CRP concentration in patients with unstable carotid artery plaque in type 2 DM complicating AMI group, with statistically significant differences (P <0.05); whereas there were no statistical differences in serum hs-CRP concentration among patients with stable carotid artery plaque, thickening membrane of carotid artery and normal carotid artery (P> 0.05). The stability of carotid plaques and serum hs-CRP concentrations had significantly negative correlation in DM complicating AMI group (P=0.000, OR=-0.386).4. ROC curve showed the sensitivity and specificity of the carotid ultrasound in the prediction of diabetes complicating AMI was 75.5% and 65.5% respectively, with 0.302 as the cutoff point; the sensitivity and specificity of the hs-CRP in the prediction of diabetes complicating AMI was 80.4% and 78.3% respectively, with 7.38 as the cutoff point; and the sensitivity and specificity of the carotid ultrasound combined with hs-CRP in the prediction of diabetes complicating AMI was 88.1% and 80.9% respectively, with 0.0105 as the cutoff point. Chi square test was conducted to test the sensitivity and specificity of the above three methods, and the combination was determined to improve the single ultrasound and hs-CRP diagnosis sensitivity and specificity, the differences were statistically significant (P <0.05).5. Areas under ROC curve of carotid ultrasound, hs-CRP detection, and a combination in the diagnosis of DM complicating AMI were 0.711,0.870 and 0.926, respectively. Z test was used to compare areas under ROC curve of three methods, and the results showed that combined use of two methods can increase the diagnosis efficiency of diabetes complicating AMI, the joint use> carotid ultrasound (Z= 8.138, P< 0.05); Joint application> hs-CRP (Z= 2.105, P< 0.05).Conclusion:Combination methods can further improve sensitivity and specificity of the single ultrasound or the hs- CRP in the diagnosis of diabetes complicating AMI, which has high clinical significance. Moreover it could be treated as a predictor for AMI in patients with type 2 DM which is conducive to the early diagnosis, prevention and treatment of diabetic vascular complication and other chronic complications. |
PDF Full Text Request