摘要
目的 开发并验证一个新的糖尿病风险模型（QDScore），用来估计10年内获得糖尿病诊断的风险，该模型的基础建立于多样化的种族和社会经济地位人群。
设计 前瞻性开放性队列研究，使用的数据常规收集于355个英格兰和威尔士全科诊所，然后使用176个独立诊所的数据来验证这一评分。
参与者 该推导模型共包括2540753例患者，年龄25—79岁，产生16436315患者年，其中78081例为新诊断2型糖尿病；验证队列包括1232832例患者（7643037患者年），其中37535例患者为新发2型糖尿病。
结局评估指标 用Cox比例风险模型估计建立队列中风险因子的效应，并且在男性和女件中推导出一个风险公式。终模型中包括的检验预测变量有：自我报告的种族、年龄、性别、体重指数、吸烟状态、糖尿病家族史、Townsend剥夺评分、已接受治疗的高血压、心血管疾病和口前使用糖皮质激素；关注的结局评估指标是在全科诊所记录中新发生的糖尿病。校正和区分度的测定在验证队列中进行计算。
结果 不同种族间2型糖尿病的风险存在4到5倍的变异。与白人参照组相比，巴基斯坦女性的调整风险比为4．07（95％可信区间3．24～5．11），巴基斯坦男性为2．54（2．20～2．93）。巴基斯坦和盂加拉困男性与印度男性相对风险比显著增高。非洲黑人男性和中国女性与对应的白人参照组相比风险增加。在验证数据中，该模型解释了51．53％的女性差异（95％可信区间50．90～52．16）和48．16％的男性差异（47．52～48．80）。风险积分显示了良好的区分能力，女性中D值达2．11（95％可信区间2．08～2．14），男性中为1．97（1．95～2．00）。模型经过很好的校正。
结论 QDScore是第一个基于前瞻性队列研究并且包括了社会等级和种族来预测糖尿病10年风险的风险预测模型。该模型不需要实验室检查，并且可以应用于临床实践，另外，还可以通过一个简单的网络计算器为公众所用（www．qdscore．org）。
Objective To develop and validate a new diabetes risk algorithm （the QDScore） for estimating 10 year risk of acquiring diagnosed type 2 diabetes over a 10 year time period in an ethnically and socioeconomically diverse population.
Design Prospective open cohort study using routinely collected data from 355 general practices in England and Wales to develop the score and from 176 separate practices to validate the score.
Participants 2 540 753 patients aged 25-79 in the derivation cohort, who contributed 16 436 135 person years of observation and of whom 78 081 had an incident diagnosis of type 2 diabetes; 1 232 832 patients （7 643 037 person years ） in the validation cohort, with 37 535 incident cases of type 2 diabetes.
Outcome measures A Cox proportional hazards model was used to estimate effects of risk factors in the derivation cohort and to derive a risk equation in men and women. The predictive variables examined and included in the final model were self assigned ethnicity, age, sex, body mass index, smoking status, family history of diabetes, Townsend deprivation score,treated hypertension, cardiovascular disease, and current use of corticosteroids; the outcome of interest was incident diabetes recorded in general practice records. Measures of calibration and discrimination were calculated in the validation cohort.
Results A fourfold to fivefold variation in risk of type 2 diabetes existed between different ethnic groups. Compared with the white reference group, the adjusted hazard ratio was 4. 07 （95% confidence interval 3. 24 to 5. 11 ） for Bangladeshi women, 4. 53 （3.67 to 5.59） for Bangladeshi men, 2.15 （1.84 to 2.52） for Pakistani women, and 2. 54 （ 2. 20 to 2. 93 ） for Pakistani men. Pakistani and Bangladeshi men had significantly higher hazard ratios than Indian men. Black African men and Chinese women had an increased risk compared with the corresponding white reference group. In the validation dataset, the model explained 51.53% （95% confidence interval 50. 90 to 52. 16 ） of the variation in women and 48. 16% （47. 52 to 48. 80） of that in men. The risk score showed good discrimination, with a D statistic of 2. 11 （95% confidence interval 2. 08 to 2. 14 ） in women and 1.97 （ 1.95 to 2. 00） in men. The model was well calibrated.
Conclusions The QDScore is the first risk prediction algorithm to estimate the 10 year risk of diabetes on the basis of a prospective cohort study and including both social deprivation and ethnicity. The algorithm does not need laboratory tests and can be used in clinical settings and also by the public through a simple web calculator （www. qdscore. org）.
出处
《英国医学杂志中文版》
2009年第5期273-282,共10页
The BMJ Chinese Edition
基金
资助（Funding） ： This study received no external funding. The authors did the work either in their personal time or during the course of their normal employment. The corresponding author （JH-C） and CC had access to all the data in the study, and all authors agreed and share responsibility for the decision to submit for publication.
