2型糖尿病患者酮症酸中毒风险预测模型的构建与验证

Establishment and Verification of Diabetic Ketoacidosis Risk Prediction Model for Type 2 Diabetic Patients

目的通过2型糖尿病酮症酸中毒风险预测模型的构建与验证,早期识别2型糖尿病酮症酸中毒的高危人群,进行针对性的预防及控制,有效降低2型糖尿病酮症酸中毒的发生率。方法选取大理州人民医院2019年1月—2020年12月住院治疗的2型糖尿病患者943例,采用Logistic回归分析筛选出独立危险因素并构建风险预测模型。选取2020年3月—2020年12月大理大学第一附属医院住院治疗的2型糖尿病患者393例对模型进行验证。结果最终急性感染(OR=8.210)、应激事件(OR=129.267)、随机静脉血糖(OR=1.986)、糖化血红蛋白(OR=1.421)4个因素构建出风险预测模型。建模组受试者操作曲线下面积为0.994,最大约登指数为0.929,灵敏度为0.954,特异度为0.975,Hosmer-Lemeshow检验P=0.975。验证组受试者操作曲线下面积为0.901,最大约登指数为0.754,灵敏度为0.889,特异度为0.865。结论急性感染、应激事件、随机静脉血糖、糖化血红蛋白是2型糖尿病酮症酸中毒发生的独立危险因素,据此构建的风险预测模型预测性能良好。

Objective To establish and verify the risk prediction model of diabetic ketoacidosis,to provide reference for the early identification,prevention and control of the disease.Methods A total of 943 patients with type 2 diabetes hospitalized in Dali People’s Hospital from January 2019 to December 2020 were selected by convenience sampling method.Logistic regression analysis was used to screen out independent risk factors to establish a risk prediction model.A total of 393 patients with type 2 diabetes hospitalized in the First Affiliated Hospital of Dali University from March 2020 to December 2020 were selected to verify the model.Results Four factors of acute infection(OR=8.210,stress events(OR=129.267),random venous blood glucose(OR=1.986),and HbA1c(OR=1.421)were included to construct a risk prediction model.The area under the ROC curve of the modeling group was 0.994;the maximum value of Youden index 0.929;the sensitivity 0.954;the specificity 0.975,and Hosmer-Lemeshow test P=0.975.The test results of the validation group indicated that the area under the ROC curve was 0.901 and the maximum value of Youden index,the sensitivity and the specificity was 0.754,0.889,and 0.865 respectively.Conclusion Acute infection,stress event,random venous blood glucose,and glycosylatedhemoglobin are independent risk factors for type 2 diabetic ketoacid,and the prediction model constructed in this study shows good prediction efficiency.