Diabetes Care：经皮氧分压可预测糖尿病患者心血管风险

　　意大利学者进行的一项研究提示，经皮氧分压（TcPO2）是无合并症2型糖尿病患者主要不良心脏事件（MACE）风险的潜在预测指标，且预测价值似乎高于踝臂指数（ABI）。研究于2013年2月12日在线发表于《糖尿病护理》（Diabetes Care）杂志。

　　该研究入选361例无合并症的2型糖尿病患者，随访45.8个月期间共发生67例MACE。研究者报告，发生MACE的受试者中ABI（≤0.9）和TcPO2（≤46 mm Hg）均降低者的比例较未发生MACE者明显增加（ABI：64.2% vs. 40.8%；TcPO2：58.2% vs. 34%）。Kaplan-Meier分析表明，ABI或TcPO2降低均与MACE风险增加有关。Cox回归分析证实，只有TcPO2降低可显著预测MACE的发生（HR=1.78，P<0.001）。

Transcutaneous Oxygen Tension As a Potential Predictor of Cardiovascular Events in Type 2 Diabetes

Comparison with ankle-brachial index

OBJECTIVE 

Transcutaneous oxygen tension (TcPO2) measures tissue perfusion and is important in the management of peripheral artery disease (PAD). Ankle brachial index (ABI) is used for the diagnosis of PAD and represents a predictor of major adverse cardiovascular events (MACE), even if in diabetes its diagnostic and predictive value seems to be reduced. No study has evaluated TcPO2 as a predictor of cardiovascular events. Aim of this longitudinal study was to assess whether TcPO2 is better than ABI at predicting MACE in type 2 diabetic patients.

RESEARCH DESIGN AND METHODS 

Among 361 consecutive patients with apparently uncomplicated diabetes, 67 MACE occurred during a follow-up period of 45.8 ± 23.2 months.

RESULTS 

The percentage of both subjects with low ABI (≤0.9) and subjects with low TcPO2 (≤46 mmHg as measured by a receiver operating characteristic curve) was significantly (<0.001) greater among patients with than among those without MACEs (ABI 64.2 vs. 40.8; TcPO2 58.2 vs. 34%). The Kaplan-Meier method showed that both low ABI (Mantel log-rank test, 4.087; P = 0.043) and low TcPO2 (Mantel log-rank test, 33.748; P > 0.0001) were associated with a higher rate of MACEs. Cox regression analysis showed that low TcPO2 (hazard ratio 1.78 [95% CI 1.44–2.23]; P < 0.001) was a significant predictor of MACE, while ABI did not enter the model.

CONCLUSIONS 

This longitudinal study showed that TcPO2 may be a potential predictor of MACE among patients with uncomplicated type 2 diabetes and that its predictive value seems to be greater than that of ABI.