2型糖尿病患者二肽基肽酶-4抑制剂治疗效果的影响因素及预测模型的构建

Influencing factors for therapeutic effect of dipeptidyl peptidase-4 inhibitor in patients with type 2 diabetes mellitus and the establishment of predictive model

目的分析2型糖尿病(T2DM)患者二肽基肽酶-4(DPP-4)抑制剂治疗效果的影响因素,并构建治疗效果的列线图预测模型。方法选取接受DPP-4抑制剂治疗的308例T2DM患者为研究对象,随机抽取216例(70%)作为训练集,92例(30%)作为验证集。根据治疗效果将训练集分为有效组和无效组,比较两组患者的一般资料及实验室指标,通过多因素Logistic回归模型分析T2DM患者DPP-4抑制剂治疗效果的影响因素,并构建治疗效果的列线图预测模型。结果有效组与无效组患者糖尿病病程、HbA1c水平、空腹血糖水平、三酰甘油水平比较,差异均有统计学意义(均P<0.05)。多因素Logistic分析结果显示,糖尿病病程、空腹血糖水平、三酰甘油水平、HbA1c水平均为T2DM患者DPP-4抑制剂治疗效果的影响因素(均P<0.05)。基于上述影响因素构建治疗效果的列线图预测模型,其一致性指数为0.837,校正曲线显示实测值与预测值基本相符;受试者工作特征曲线分析显示,外部验证时预测模型的曲线下面积为0.777。结论糖尿病病程、HbA1c水平、空腹血糖水平、三酰甘油水平是T2DM患者DPP-4抑制剂治疗效果的影响因素,由上述4个指标构建的预测模型对治疗效果具有较高的预测价值。

Objective To analyze the influencing factors for therapeutic effect of dipeptidyl peptidase-4(DPP-4)inhibitor in patients with type 2 diabetes mellitus(T2DM),and to establish the Nomogram predictive model of therapeutic effect.Methods A total of 308 T2DM patients receiving DPP-4 inhibitor for treatment were selected as the research subjects,therein 216 cases(70%)were randomly extracted as the training set,and 92 cases(30%)as the validation set.The training set was divided into the effective group or the ineffective group according to the therapeutic effect.The general data and laboratory indicators were compared between the two groups.The influencing factors for therapeutic effect of DPP-4 inhibitor in T2DM patients were analyzed by the multivariate Logistic regression model,and the Nomogram predictive model of therapeutic effect was established.Results There were statistically significant differences in the disease course of diabetes mellitus,HbA1c level,fasting blood glucose level,and triglyceride level between the two groups(all P<0.05).The results of multivariate Logistic analysis revealed that disease course of diabetes mellitus,fasting blood glucose level,triglyceride level and HbA1c level were the influencing factors for therapeutic effect of DPP-4 inhibitor in T2DM patients(all P<0.05).The Nomogram predictive model of therapeutic effect was established based on the influencing factors as above,and the consistency index of the model was 0.831.The calibration curve depicted that the actual value was basically consistent with the predicted value.The receiver operative characteristic curve analysis showed that the area under the curve of the predictive model was 0.777 when external validation was conducted.Conclusion Disease course of diabetes mellitus,HbA1c level,fasting blood glucose level,and triglyceride level are the influencing factors for therapeutic effect of DPP-4 inhibitor in T2DM patients,and the predictive model established based on the 4 indices mentioned above exerts a relatively high predictive value of therapeutic effect.