基于超声指标和临床资料的列线图预测糖尿病肾病高风险患者疾病进展的价值

Value of nomogram based on ultrasound index and clinical data in predicting disease progression in high-risk diabetic kidney disease patients

目的基于超声指标和临床资料构建预测糖尿病肾病(DKD)高风险患者2年内出现疾病进展的列线图模型,探讨其临床应用价值。方法前瞻性筛选符合DKD高风险标准的2型糖尿病患者443例并随访2年,根据期间是否进展为DKD分为DKD组与非DKD组,比较两组超声指标和临床资料的差异。采用单因素和多因素COX回归分析筛选DKD高风险患者2年内出现疾病进展的独立危险因素,构建列线图模型。绘制受试者工作特征(ROC)曲线评价模型的区分度;采用校准曲线评估模型的拟合优度;采用临床决策曲线评估模型的临床净收益。结果最终371例DKD高风险患者完成随访,其中DKD组63例,非DKD组308例。DKD组年龄、糖尿病病程、糖化血红蛋白、肾叶间动脉阻力指数、基线尿白蛋白与肌酐比值及合并糖尿病视网膜病变、高血压、血脂紊乱占比均高于非DKD组,差异均有统计学意义(均P<0.05)。单因素和多因素COX回归分析显示,糖尿病病程、肾叶间动脉阻力指数、合并糖尿病视网膜病变及高血压均为DKD高风险患者2年内出现疾病进展的独立危险因素(均P<0.05)。基于上述独立危险因素构建列线图模型,ROC曲线分析显示模型具有较好的区分度,曲线下面积为0.783(95%可信区间:0.738~0.824),高于各因素单独应用(均P<0.05);校准曲线显示模型拟合度较好(χ^(2)=6.392,P=0.592);临床决策曲线显示模型具有良好的临床净收益。结论基于超声指标和临床资料构建的列线图模型可较好地预测DKD高风险患者2年内出现疾病进展的风险,具有较好的临床应用价值。

Objective To establish a nomogram model based on ultrasound index and clinical data in predicting disease progression within 2 years in high-risk diabetic kidney disease(DKD)patients,and to explore its clinical application value.Methods A total of 443 patients with type 2 diabetes who met the high-risk criteria for DKD were prospectively screened and followed up for 2 years.Patients who progressed to DKD during this period were defined as the DKD group,while those who did not progressed were defined as the non-DKD group.Univariate and multivariate COX regression were used to analyze the independent risk factors for disease progression within 2 years in high risk patients with DKD,and a nomogram model was established.Receiver operating characteristic(ROC)curve was drawn to evaluate the differentiation of the model.Calibration curve was used to evaluate the goodness of fit of the model.Clinical decision curve was used to evaluate the clinical net benefit of the model.Results A total of 371 high-risk DKD patients were followed up,including 63 cases in the DKD group and 308 cases in the non-DKD group.The age,duration of diabetes,glycosylated hemoglobin,renal interlobar resistance index,baseline urinary protein to creatinine ratio and the proportion of diabetic retinopathy,hypertension,dyslipidemia in DKD group were higher than those in non-DKD group,the differences were statistically significant(all P<0.05).Univariate and multivariate COX regression analysis showed that the duration of diabetes,renal interlobar resistance index,and the presence of diabetic retinopathy and hypertension were independent risk factors for disease progression within 2 years in high-risk DKD patients(all P<0.05).The nomogram model was established based on above independent risk factors,ROC curve analysis showed the model had good discrimination,the area under the curve was 0.783(95%confidence interval:0.738~0.824),which was higher than that of individual factor,and the differences were statistically significant(all P<0.05).In addition,the calibration curve showed a good fitting(χ^(2)=6.392,P=0.592),and the clinical decision curve had a good net benefit.Conclusion The nomogram based on ultrasound index and clinical data has good clinical application value in predicting the disease progression within 2 years in high-risk DKD patients.