基于社区2型糖尿病患者的心脑血管事件5年风险预测模型

A prediction model of 5-year CVD risks for type 2 diabetic patients:a prospective cohort study among Chinese community population

目的构建新诊断的2型糖尿病患者5年内首次发生心脑血管事件的预测模型。方法研究对象选自青岛市黄岛区疾病预防控制中心慢性病管理系统,选择未发生过心脑血管事件的2型糖尿病患者2 899例作为训练样本,建立Cox模型和评分模型,并对模型进行内部验证;用"山东多中心健康管理纵向观察队列"中的1 016例2型糖尿病患者作为验证样本,对模型进行外部验证。结果随访期间训练样本共发生228例心脑血管事件,发病密度为16.86‰。模型变量包括年龄、性别、收缩压、低密度脂蛋白、高密度脂蛋白和心脑血管病家族史。训练样本Cox模型ROC曲线下面积(AUC)为0.678(95%CI:0.660~0.695),评分模型AUC为0.663(95%CI:0.648~0.680);外部验证Cox模型AUC为0.640(95%CI:0.608~0.676),评分模型AUC为0.631(95%CI:0.600~0.661)。结论研究建立的2型糖尿病患者心脑血管事件5年预测模型可以为社区糖尿病患者管理初期提供参考。

Objective To construct a prediction model for risks of cardio-cerebrovascular disease （CVD） in 5 years for newly diagnosed type 2 diabetic patients in China. Methods We collected from an official chronic disease prevention and control project 2 899 participants newly diagnosed as diabetic who were free from CVD events. Cox proportionalhazards regression model was used to construct a 5-year CVD risk model. Calibration and goodness of fit test were ap- plied. External validation based on Shandong Multi-center Health Management Large Database was adopted to assess the stability of model. Results a total of 228 first CVD events were recorded in the derivation cohort during an average follow-up of 4.7 years （ 16.86/1 000 person-year）. The 6 variables included age, gender, systolic pressure, low-densi- ty lipoprotein, high-density lipoprotein and family history of CVD. In the derivation cohort, the area under the receiver operating characteristic curve （AUC） for the Cox model and scoring model was 0. 678 （95% CI： 0. 660-0. 695） and 0. 663 （95% CI： 0. 648-0. 680）, respectively. In the external validation, the AUC for the Cox model and scoring mod- elwas0.640 （95%CI： 0.608-0.676） and0.631 （95% CI：0.600-0.661）, respectively. Conclusion We have es- tablished a model to predict the 5-year risks of CVD in Chinese type 2 diabetic patients, which can be used for the early intervention of CVD among type 2 diabetic patients in residential communities.