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目的:评价高敏C反应蛋白(hsCRP)水平与活动平板运动试验心率恢复(HRR)对2型糖尿病患者新发心血管事件的预测作用。方法:检测156例2型糖尿病患者血清hsCRP,根据检测结果分为hsCRP正常组、hsCRP异常组;再于当日或一周内行活动平板运动试验,根据运动后HRR情况分为HRR正常组、HRR异常组;并根据血清hsCRP正常、异常和HRR正常、异常进行交叉组合分成4组:Ⅰ组为hsCRP正常、HRR正常,Ⅱ组为hsCRP正常、HRR异常,Ⅲ组为hsCRP异常、HRR正常,Ⅳ组为hsCRP异常、HRR异常。每半年收集1次新发心血管事件的情况,随访2年～3年。结果:1、发生心血管事件52例,总发生率33.3%。2、hsCRP正常组、异常组心血管事件发生率分别为16.4%和46.1%,两者间有显著差异;将hsCRP异常作为预测标准,其相对危险度为2.8。3、HRR正常组、异常组心血管事件发生率分别为3.2%和53.8%,两者间有显著差异;将HRR异常作为预测标准,其相对危险度为16.9。4、Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组的心血管事件发生率分别为2.9%、31.3%、3.6%、65.6%,4组间有显著差异。其中,Ⅰ组与Ⅲ组间无显著差异,Ⅰ组、Ⅲ组与Ⅱ组、Ⅳ组间差异有统计学意义;Ⅱ组与Ⅳ组间有显著差异。Ⅱ组、Ⅲ组、Ⅳ组相对于Ⅰ组的相对危险度分别是10.9、1.3、23。结论:HRR异常及hsCRP异常均是糖尿病患者发生心血管事件的风险预测指标,且HRR异常的预测价值更高;联合应用hsCRP与HRR两项指标对糖尿病患者进行心血管事件的筛查,可进一步提高对风险评估的准确率,对糖尿病患者心血管事件的预测具有重要的临床意义。
Objective: To evaluate the predictive value of high sensitivity C-reactive protein (hsCRP) and exercise-induced cardiorespiratory recovery (HRR) on new-onset cardiovascular events in patients with type 2 diabetes mellitus. Methods: Serum hsCRP was detected in 156 patients with type 2 diabetes mellitus. According to the test results, the hsCRP was divided into normal hsCRP group and abnormal hsCRP group. On the same day or week, the activity of hsCRP was divided into HRR normal group, HRR abnormal group ; According to the normal serum hsCRP, abnormal and HRR normal, abnormal cross-combination is divided into 4 groups: Ⅰ group hsCRP normal, HRR normal, Ⅱ hsCRP normal group, abnormal HRR, Ⅲ group hsCRP abnormalities, HRR normal, Ⅳ group hsCRP abnormalities, HRR abnormalities. A new cardiovascular event was collected every six months and followed up for 2 years to 3 years. Results: 1, cardiovascular events occurred in 52 cases, the total incidence of 33.3%. The incidence of cardiovascular events in the normal group and abnormal group were 16.4% and 46.1% respectively, there was a significant difference between the two groups. The relative risk of hsCRP as the prediction standard was 2.8.3, and the HRR normal group and abnormal group The incidence of cardiovascular events were 3.2% and 53.8%, respectively, with significant difference between them. The relative risk of HRR abnormality was 16.9.4. The cardiovascular risk of group Ⅰ, group Ⅱ, group Ⅲ and group Ⅳ Incidence rates were 2.9%, 31.3%, 3.6%, 65.6%, there were significant differences among the four groups. Among them, there was no significant difference between group Ⅰ and group Ⅲ, there was significant difference between group Ⅰ, group Ⅲ and group Ⅱ, group Ⅳ; There was significant difference between group Ⅱ and group Ⅳ. The relative risk of group Ⅱ, Ⅲ and Ⅳ relative to group Ⅰ was 10.9, 1.3 and 23, respectively. Conclusion: Abnormal HRR and abnormal hsCRP are risk predictors of cardiovascular events in patients with diabetes mellitus, and the predictive value of HRR abnormalities is higher. Combined application of hsCRP and HRR in the screening of cardiovascular events in patients with diabetes mellitus can further Improve the accuracy of risk assessment, the prediction of cardiovascular events in patients with diabetes has important clinical significance.