糖尿病风险评估不同方法应用比较

Comparison of different diabetes risk score in screening of individual with high risk of diabetes

目的比较中国成年人糖尿病发病风险评估方法(HCI)与阿曼糖尿病风险评估方法筛检糖尿病高危人群的准确性。方法对1 029名23～62岁的研究对象进行现况调查,应用2种糖尿病风险评估方法筛检糖尿病高危人群,用1999年WHO糖尿病诊断标准作为诊断糖尿病患者的金标准,用Z检验比较2种评估方法的接收者工作特征曲线ROC下面积。结果HCI与阿曼糖尿病风险评估方法分别以≥1.10,>10为判断点筛检糖尿病高危人群,ROC曲线下面积分别为0.82(95%CI=0.77～0.88)、0.80(95%CI=0.72～0.87),灵敏度分别为0.95,0.63,特异度分别为0.41,0.73;2种方法分别筛出高危者618人(60.06%)和295人(28.67%),总体一致性较弱,Kappa值为0.29,但阿曼糖尿病风险评估方法筛出的高危者中87.46%同时被HCI确定为高危,HCI筛出的正常者中91.00%同时被阿曼糖尿病风险评估方法确定为正常者;用Z检验比较2种评估方法的ROC曲线下面积,Z=0.65<1.96,P>0.05,差异无统计学意义。结论中国成年人糖尿病发病风险评估方法与阿曼糖尿病风险评估方法均具有一定的准确性,各自的判断点能够区分高危者与正常者;2种方法筛检高危者具有良好的一致性;Z检验表明,尚不能认为2种方法筛检糖尿病高危人群的准确性有差异。

Objective To compare the validity of ＂a risk model for prediction of diabetes in Chinese adults（HCI）＂ and ＂diabetes risk in Oman（Oman）＂in the screening of individuals with high risk of diabetes mellitus.Methods A total of 1029 subjects aged 23-62 years were investigated with a cross-sectional study.Risk score method and WHO 1999 gold standard were adopted to screen high risk individual.Z test was used to compare the areas under ROC（receiver operating characteristic）.Results HCI and Oman risk score of ≥1.10,10 was used as the optimal cut-point to screen individuals at high risk,respectively.The areas under ROC were 0.82（95% confidence interval：0.77-0.88） and 0.80（95% CI：0.72-0.87）.The sensitivity was 95%,63% and the specificity was 41%,73%,respectively.The number of individuals at high risk screened by HCI and Oman risk score were 618（60.06%） and 295（28.67%）,respectively,with a poor whole agreement（Kappa = 0.29）.But 87.46% of the individuals at high risk screened by Oman were included by HCI,and 91.00% healthy individuals screened by HCI were also included by Oman.The Z value was 0.65（P0.05）,and the difference between two methods was not significant.Conclusion HCI and Oman risk score both have a certain validity,and their cut-off can distinguish individuals at high risk from healthy to some extent.The individuals at high risk screened by Oman and HCI have a good agreement.Z test shows that the validities of the two methods are not different in screening individual at high risk of diabetes.