危险因素记分法筛检无症状糖尿病及其评价

The use of risk factors scoring method in screening for undiagnosed diabetes in general population

目的 建立自然人群中无症状糖尿病的筛检方法。方法 在非胰岛素依赖型糖尿病流行病学调查的基础上,分别选择两组人群进行危险因素记分法及其应用价值研究。人群A用于危险因素记分方法的建立,采用logistic回归分析筛选糖尿病的危险因素,根据危险因素的OR值确定不同变量的记分值,以累计记分值的大小判断个体患病的危险性,并以人群B的资料验证该方法进行人群筛检的真实性和有效性。结果 随着累计记分值的增加,人群中无症状糖尿病的患病风险亦随之增高,趋势性χ2检验具有非常显著的统计学意义(P<0.01)。当判别阈值定为7时,该方法对人群中无症状糖尿病筛检的灵敏度和特异度分别为74.30%和63.20%,阳性预测值为4.20%,阴性预测值达99.20%。结论 本法简便、易行、经济,有利于获得满意的受检率,可用于糖尿病个体和群体(社区)的患病危险度测定及健康教育,有望成为糖尿病人群筛检的有效和实用的方法。

Objective Based on an epidemiological survey of NIDDM in the general population, two sub-population groups were selected to develop a screening method on risk factors to identify people at increased risk for undiagnosed diabetes. Methods Logistic regression analysis on the original data of population A was carried out to screen the main risk factors of diabetes. The score of the variables was determined based on the OR value and the aggregate score was used to predict the risk of undiagnosed diabetes. Both validity and effectiveness of the method were evaluated in population B. Results Results showed that the risk of having diabetes in the population increased along with aggregate scores of the method. Trend χ 2 test showed statistical significance ( P <0.01). When the threshold value was set up at 7, both sensitivity and specificity for identifying undiagnosed diabetes were 74.3% and 63.2%, respectively making the positive predictive value 4.2% and negative predictive value 99.2 %. Conclusion The benefits of this screen method seemed to be simple,economical and helpful to obtain a satisfactory response rate. The method could be used for health education and to identify people (community) at high risk for potential diabetes. It was predicted that this screening method could serve as an effective and useful tool for mass screening of NIDDM.