2型糖尿病患者并发糖尿病肾病的危险因素及Nomogram风险预测模型构建

Risk factors of diabetic nephropathy in patients with type 2 diabetes mellitus and construction of a Nomogram risk prediction model

目的:探讨2型糖尿病患者并发糖尿病肾病(DN)的危险因素,并构建Nomogram风险预测模型。方法:选取2020年5月至2022年12月首都医科大学附属北京友谊医院收治的2型糖尿病患者200例作为研究对象,根据是否并发DN,分为合并DN组(n=76)和未合并DN组(n=124),收集所有患者一般资料和血生化指标,采用多因素logistic回归分析法分析2型糖尿病患者并发DN的影响因素;采用R语言软件4.0“rms”包构建Nomogram风险预测模型。结果:合并DN组患者2型糖尿病病程≥10年占比、合并高血压占比明显高于未合并DN组(P<0.05)。合并DN组患者总胆固醇(TC)、低密度脂蛋白胆固醇(LDLC)、高敏C反应蛋白(hs-CRP)、糖化血红蛋白(HbAlc)、尿白蛋白排泄率(UAER)、肌酐(Cr)、血尿素氮(BUN)、胱抑素C(Cys C)水平明显高于未合并DN组(P<0.05),合并DN组患者高密度脂蛋白胆固醇(HDL-C)、血清C肽(FCP)、肾小球滤过率(eGFR)水平明显低于未合并DN组(P<0.05)。多因素logistic回归分析结果显示,2型糖尿病病程≥10年、合并高血压、HbAlc、UAER、PMPs、Cys C为2型糖尿病患者并发DN的独立危险因素(P<0.05)。Nomogram风险预测模型预测2型糖尿病患者发生DN的一致性指数(C-index)为0.786(95%CI:0.681~0.877),校准曲线趋于理想曲线,表明该模型具有较好的精确度。结论:2型糖尿病病程≥10年、合并高血压、HbAlc、UAER、PMPs、Cys C均为2型糖尿病患者并发DN的独立危险因素,基于血清学指标构建的Nomogram风险预测模型可更准确的评估DN发生的风险。

Objective:To analyze the risk factors of diabetic nephropathy(DN)in patients with type 2 diabetes mellitus and construct a Nomogram risk prediction model.Methods:A total of 200 patients with type 2 diabetes mellitus admitted to Beijing Friendship Hospital,Capital Medical University from May 2020 to December 2022 were selected as the study subjects and divided into the combined DN group(n=76)and the uncomplicated DN group(n=124)according to whether they were complicated with DN,and the general data and blood biochemical indexes of all the patients were collected.The influencing factors of type 2 diabetes mellitus patients’complication with DN were analyzed by multifactorial logistic regression and the Nomogram risk prediction model was constructed by R language software 4.0“rms”package.Results:The proportion of patients with a duration of type 2 diabetes mellitus≥10 years and the proportion of patients with hypertension in the combined DN group were significantly higher than those in the uncomplicated DN group(P<0.05).The levels of total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-sensitivity C-reactive protein(hs-CRP),glycosylated hemoglobin(HbAlc),urinary albumin excretion rate(UAER),creatinine(Cr),blood urea nitrogen(BUN),and cystatin C(Cys C)in the combined DN group were significantly higher than those in the uncombined DN group(P<0.05)and the levels of high-density lipoprotein cholesterol(HDL-C),serum C-peptide(FCP)and glomerular filtration rate(eGFR)in patients in the combined DN group were significantly lower than those in patients in the combined DN group(P<0.05).The results of multifactorial logistic regression analysis showed that a duration of type 2 diabetes mellitus≥10 years,combined hypertension,HbAlc,UAER,PMPs,and Cys C were the independent risk factors for DN complication in patients with type 2 diabetes mellitus(P<0.05).The concordance index(C-index)of Nomogram risk prediction model for predicting DN in patients with type 2 diabetes mellitus was 0.786(95%CI:0.681-0.877)and the calibration curve tended to the ideal curve,indicating that the model had good accuracy.Conclusion:The duration of type 2 diabetes mellitus≥10 years,combined hypertension,HbAlc,UAER,PMPs,and Cys C are independent risk factors for DN complication in patients with type 2 diabetes mellitus,and the Nomogram risk prediction model constructed on the basis of serologic indicators can more accurately assess the risk of DN occurrence.