糖尿病视网膜病变家庭预测模型的建立与验证

Establishment and Verification of a Family Prediction Model for Diabetic Retinopathy

目的建立糖尿病视网膜病变(DR)的家庭预测模型并验证其有效性。方法选取2008—2016年在无锡市人民医院内分泌科住院的879例糖尿病(DM)患者作为研究对象,采集性别、年龄、体质指数(BMI)、糖尿病病程、空腹末梢血糖(FBG)、收缩压(SBP)、舒张压(DBP)、吸烟、他汀应用共9项家庭中易观察的指标,利用多因素二元logistic回归分析DR的危险因素并建立预测模型,采用受试者工作曲线(ROC曲线)评估该模型对DR的预测价值。结果研究纳入879例DM患者,其中DR组450例,无DR组429例。多因素二元logistic回归显示,年龄(β=-0.038,OR=0.963,P<0.001),糖尿病病程(β=0.115,OR=1.122,P<0.001),FBG(β=0.079,OR=1.082,P=0.002),SBP(β=0.019,OR=1.019,P=0.004),他汀应用(β=-0.374,OR=0.688,P=0.046)与DR的发生显著相关,据此建立DR的家庭预测模型:Y=1/[1+e-(-0.526-0.038X1+0.115X2+0.079X3+0.019X4-0.374X5)],其中X1=年龄,X2=糖尿病病程,X3=FBG,X4=SBP,X5=他汀应用。该模型的ROC曲线下面积为0.719,临界值为0.759时约登指数最大,对应敏感度为59.3%,特异度为76.2%。结论糖尿病患者的年龄、糖尿病病程、FBG、SBP、他汀应用与DR显著相关,据此建立的DR家庭预测模型的敏感度为59.3%,特异度为76.2%,ROC曲线下面积为0.719,表明该模型对DR有中等程度的预测价值。

A total of879patients with diabetes mellitus(DM)admitted to the Department of Endocrinology,Wuxi People's Hospital from2008to2016were enrolled in the study.Gender,age,body mass index(BMI),duration of diabetes,fasting peripheral blood glucose(FBG),and systolic blood pressure(SBP),diastolic blood pressure(DBP),smoking,and statin were used to identify indicators in9households were collected.Multivariate binary logistic regression was used to analyze risk factors for DR and predictive models were used.Subject operating curve(ROC curve)was used to evaluate the predictive value of the model for DR.Results The study included879patients with DM,including450in the DR group and429in the non-DR group.Multivariate binary logistic regression showed age(β=-0.038,OR=0.963,P<0.001),duration of diabetes(β=0.115,OR=1.122,P<0.001),FBG(β=0.079,OR=1.082,P=0.002),SBP(β=0.019,OR=1.019,P=0.004),statin application(β=-0.374,OR=0.688,P=0.046)was significantly associated with the occurrence of DR,and the family prediction of DR was established accordingly.Model:Y=1/[1+e-(-0.526-0.038X1+0.115X2+0.079X3+0.019X4-0.374X5)],where X1=age,χ^2=diabetic course,X3=FBG,X4=SBP,X5=statin application.The area under the ROC curve of the model was0.719,and the critical value was0.759,the Yoden index was the largest,the corresponding sensitivity was59.3%,and the specificity is76.2%.Conclusion Age,duration of diabetes,FBG,SBP,and statin use were significantly associated with DR.The sensitivity of the DR family prediction model was59.3%,specificity was76.2%,and the area under the ROC curve was0.719.This model has a moderate predictive value for DR.