不同评估方法在T2DM心血管病风险评估中的应用

Application of Different Assessment Methods in Cardiovascular Disease Risk Assessment of T2DM

目的分析Framinghan、ADVANCE-Risk评分表与“糖心风险评估”、“CV风险评估”模型评估对T2DM患者未来10 a心血管疾病死亡风险评估的一致性。方法回顾性收集昆明医科大学第二附属医院内分泌科2018年1月至2020年12月符合2型糖尿病诊断标准住院患者527例:(1)使用“糖心风险评估”模型与Framingham评分分别评估未来10 a心血管病发病风险;(2)纳入增加糖尿病病程、UACR等指标的患者148例,使用ADVANCE-Risk评分和“CV风险评估项目”,分别评估同一患者的未来10 a心血管病死亡风险。以上2组均采用Kappa值来评估2种方法结果的一致性。结果(1)院内风险评估模型“糖心风险评估”结果中:中危组431人(81.78%),Friminghan评分评估结果为:高危组250人(47.44%)。SPSS分析得出Kappa值,K=0.051,P=0.001;(2)院内风险评估模型“CV风险项目”结果中:极高危组98人(66.22%),ADVANCERisk模型评估结果为:极高危组76人(50%)。SPSS分析得出Kappa值,K=0.492,P=0.000。结论“糖心风险评估”模型与Framingham评分对2型糖尿病患者未来10 a心血管病发生风险的评估结果一致性差。“CV风险评估项目”和ADVANCE-Risk评分对2型糖尿病患者未来10 a心血管病死亡风险的评估结果一致性中等。

Objective To analyze the consistency between the Framinghan,the advance-risk scale and the“sugar-heart risk assessment”,the“CV risk assessment”model on the risk of cardiovascular death in T2DM patients in the next 10 years.Methods A retrospective study of 527 inpatients who met the diagnostic criteria for type 2 diabetes in the Department of Endocrinology,The Second Affiliated Hospital of Kunming Medical University from January 2018 to December 2020 was conducted.The Framinghan rating scale and the Cardiovascular risk assessment for diabetes mellitus model were used to assess the occurrence risk of cardiovascular disease over the next 10 years.148 patients with increased diabetes duration,UACR and other indicators were included.ADVANCE Risk score and CV Risk Assessment project were used to evaluate the risk of cardiovascular death of the same patient in the next 10 years.Kappa values were used to evaluate the consistency of the results of the two methods.Results The result of Cardiovascular risk assessment for diabetes mellitus model:431 patients(81.78%)in the mediumrisk group,and 250 patients(47.44%)in the high-risk group using Framinghan rating scale.SPSS analysis showed Kappa value,K=0.051,P=0.001;The result of CV Risk assessment:98 patients(66.22%)in the very high Risk group,and 76 patients(50%)in the ADVANCE Risk model.SPSS analysis showed Kappa value,K=0.492,P=0.000.Conclusion In this study,the“Cardiovascular risk assessment for diabetes mellitus”model and Framinghan rating scale in assessing the occurrence risk of cardiovascular disease in patients with type 2 diabetes in the next 10 years were very inconsistent.The“CV Risk assessment”and ADVANCE Risk model had moderate consistency in assessing the mortality risk of cardiovascular in patients with type 2 diabetes over the next 10 years.