基于门诊电子病历数据中老年2型糖尿病患者共病模式分析

Patterns of multimorbidity in middle-aged and elderly type 2 diabetes patients:an electronic outpatient medical record-based analysis

目的了解中老年2型糖尿病患者的共病模式和核心共病,为中医健康管理和临床治疗指南的完善提供科学依据。方法收集2015年1月1日—2019年12月31日在中国中医科学院西苑医院就诊的21425例中老年2型糖尿病患者门诊电子病历数据,采用关联规则挖掘识别2型糖尿病患者常见的二元共病模式,并构建2型糖尿病患者的共病网络,依据网络拓扑学指标判断共病网络中的核心共病。结果21425例中老年2型糖尿病患者中,存在共病者17843例(83.3%);冠心病、充血性心衰、心房颤动、缺血性脑卒中、高血压、血脂异常、动脉硬化、慢性阻塞性肺疾病、哮喘、慢性肾炎、慢性肝炎、类风湿性关节炎、骨关节炎、骨质疏松、抑郁症和焦虑症等16种慢性病共形成了76个有意义的二元共病模式,以支持度排序,最常见的二元共病模式为“冠心病+高血压”(支持度=0.45,提升度=1.31),高血压和冠心病存在于15个二元疾病模式中;在中医就诊的中老年2型糖尿病患者中,共病网络图显示高血压、冠心病、血脂异常、骨质疏松和骨关节炎间的共患率较高,存在复杂的共患关系;共病网络中,节点度和紧密度最大的疾病为冠心病和高血压(节点度=15,紧密度=0.45);结合点度、点权、紧密度和特征向量中心性指标发现,高血压、冠心病、血脂异常、骨关节炎和骨质疏松位于网络的枢纽位置,为中老年2型糖尿病患者的核心共病。结论高血压、冠心病、血脂异常、骨关节炎和骨质疏松是中老年2型糖尿病患者的核心共病,患者和医疗机构应针对这些疾病进行有效预防和管理。

Objective To identify multimorbidity patterns and major comorbidities in middle-aged and elderly patients with type 2 diabetes mellitus(T2DM)for providing evidence to the improvement of traditional Chinese health management and clinical guidelines on multimorbidity.Methods We extracted electronic medical records of 21425 T2DM patients aged≥45 years and seeking medication from January 1,2015 to December 31,2019 in Xiyuan Hospital of the Chinese Academy of Chinese Medical Sciences.Association rule mining was used to identify common binary patterns of multimorbidity in the patients and the multimorbidity network for the T2DM patients was constructed.The major comorbidities were identified according to the network topological index.Results Of all the T2DM patients,83.3%(17843)were diagnosed with 16 other chronic diseases.Among the 16 chronic diseases(including coronary heart disease,congestive heart failure,atrial fibrillation,ischemic stroke,hypertension,dyslipidemia,atherosclerosis,chronic obstructive pulmonary disease,asthma,chronic nephritis,chronic hepatitis,rheumatoid arthritis,osteoarthritis,osteoporosis,depression,and anxiety),totally 76 types of binary patterns of multimorbidity were found,with the most common comorbidity of coronary heart disease and hypertension(support index=0.45,lift index=1.31)according the rank of support index and hypertension and coronary heart disease being the diseases in 15 binary comorbidities.For the T2DM patients treated with traditional Chinese medicine,the multimorbidity network plot suggested higher multimorbidity rates among hypertension,coronary heart disease,dyslipidemia,osteoporosis and osteoarthritis diseases,indicating a complex multimorbidity relationship.In the multimorbidity network constructed,coronary heart disease and hypertension were identified with the greatest node and closeness degree(nodes=15,closeness index=0.45).Based on the degrees of node,strength,closeness and eigenvector centrality,hypertension,coronary heart disease,dyslipidemia,osteoarthritis and osteoporosis were at the key positions in the multimorbidity network constructed and were the major comorbidities among the T2DM patients.Conclusion Among middle-aged and elderly patients with type 2 diabetes mellitus,hypertension,coronary heart disease,dyslipidemia,osteoarthritis and osteoporosis are the major comorbidities and the comorbities need to be concerned for effective prevention and management on multimorbidity in the patients.