简易糖尿病肾病风险评分在2型糖尿病患者中的应用及效果评价

A simple nonlaboratory-based risk score to identify diabetic kidney disease in Chinese patients with type 2 diabetes mellitus

目的建立一个简单的糖尿病肾病风险评分应用于2型糖尿病患者中筛查糖尿病肾病高危人群。方法2014年8月至2015年12月,从郑州市6个社区中随机抽取年龄≥40岁的2型糖尿病患者1035例。随机抽取约70%的样本作为训练样本,用于建立糖尿病肾病风险评分表,其余30%样本为验证样本。将年龄、糖尿病病程、高血压病史、体质指数、腰围、规律运动及饮食控制作为候选危险因素。2组间比较采用t检验,以多变量logistic回归分析的偏回归系数计算糖尿病肾病风险评分值。采用受试者工作特征曲线(ROC)和计算ROC曲线下面积(AUC)分析风险评分筛查糖尿病视网膜病的效能。结果糖尿病肾病风险评分由年龄、糖尿病病程和高血压病史组成。训练样本的ROC曲线下面积为0.723(95%CI0.677~0.769),根据约登指数筛查糖尿病肾病的最佳切点为11。采用切点值11筛查糖尿病肾病,训练样本的灵敏度和特异度分别为66.7%和72.8%,检验样本结果与训练样本相似(63.6%和75.8%)。结论糖尿病肾病风险评分可作为初步筛查糖尿病肾病高危人群的工具。

Objective To develop a simple risk score to screen diabetic kidney disease (DKD) in Chinese patients with type 2 diabetes mellitus (T2DM). Methods A multicentric community-based cross-sectional study was carried out in central urban China between Aug 2014 and Nov 2015. A total of 713 patients (approximately 70%) were selected using systematic random sampling method as training samples to formulate the risk score, and the remaining 322 patients (approximately 30%) were used as test samples. Age, duration of diabetes mellitus, history of hypertension, body mass index, waist circumference, physical inactivity and diet control were considered as candidate risk factors.β-coefficients derived from a multiple logistic regression model predicting the presence of DKD were used to calculate the risk score. Cross-validation was used to validate the method for establishment of the risk score. Results The risk score was composed of age, duration of diabetes mellitus, and history of hypertension. The area under the receiver operating characteristics curve for DKD was 0.723 (95%CI 0.677-0.769). Comparing the Youden′s Index of different values, the optimal cutoff point was 11 to predict DKD. Using the cut-off value of 11 points to screen DKD, the sensitivity and specificity in test samples (63.6% and 75.8%) was similar as that in training samples (66.7% and 72.8%). Conclusion The risk score could be a reliable primary assessment tool to screen DKD in Chinese patients with T2DM.