2型糖尿病并发胃肠动力障碍现况及风险预测模型建立和效果评价

Establishment of a risk prediction model for gastrointestinal motility disorder in patients with type 2 diabetes mellitus

背景胃肠动力障碍是糖尿病常见并发症,随病情进展,极易引发胃轻瘫、肠动力下降,影响胃肠道消化吸收,加重代谢紊乱.目前,临床缺乏对糖尿病人群胃肠动力障碍风险因素的研究,难以对临床诊断及早期防控提供指导意见.目的观察2型糖尿病(type 2 diabetes mellitus,T2DM)患者胃肠动力障碍发生情况,进一步构建风险预测模型,为临床防控提供指导.方法选取2022-10/2023-04我院T2DM患者468例,统计胃肠动力障碍发生情况,Logistic回归分析T2DM发生胃肠动力障碍的影响因素,进一步建立列线图预测模型,采用受试者工作特征(receiver operating characteristic,ROC)曲线、校准曲线及决策曲线(decision curve analysis,DCA)评价列线图预测模型的临床效用.结果468例T2DM患者,胃肠动力障碍发生率为44.84%;胃动力过缓(OR=4.553,P<0.05)、视网膜病变(OR=4.676,P<0.05)、周围神经病变(OR=3.652,P<0.05)、空腹血糖(fasting plasma glucose,FPG)(OR=5.775,P<0.05)、餐后2h血糖(2h postprandial glucose,2hPG)(OR=3.627,P<0.05)、糖化血红蛋白(hemoglobin A1c,HbAlC)(OR=5.792,P<0.05)、胃肠道症状评定量表(gastrointestinal symptom rating scale,GSRS)评分(OR=3.939,P<0.05)、汉密尔抑郁量表(Hamilton Depression Scale,HAMD)评分(OR=3.545,P<0.05)、汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)评分(OR=4.108,P<0.05)、糖尿病病程(OR=6.384,P<0.05)、体质量指数(body mass index,BMI)(OR=3.809,P<0.05)是T2DM患者胃肠动力障碍的独立危险因素;ROC曲线显示列线图模型预测T2DM患者胃肠动力障碍的敏感度、特异度分别为82.36%、96.47%;校准曲线及DCA提示实际及列线图预测模型预测概率值基本呈线性正相关,实际曲线与理想曲线基本重合,且列线图在预测T2DM患者胃肠动力障碍方面具有较好的临床适用性.结论T2DM患者存在胃肠运动障碍风险,且胃动力过缓、视网膜病变、周围神经病变、FPG、2hPG、HbAlc、GSRS评分、HAMD评分、HAMA评分、糖尿病病程、BMI等是其影响因素,临床工作中加强预测模型构建,可筛选识别高危人群,为临床防控干预提供指导.

BACKGROUND Gastrointestinal motility disorder is a common complication of diabetes,which often leads to gastroparesis and decreased intestinal motility as the disease progresses,affecting gastrointestinal digestion and absorption and aggravating metabolic disorders.Currently,there is a lack of research on the risk factors for gastrointestinal motility disorder in diabetic patients,making it difficult to provide guidance for its clinical diagnosis and early prevention and control.AIM To observe the incidence of gastrointestinal motility disorder in patients with type 2 diabetes mellitus(T2DM),and construct a risk prediction model for gastrointestinal motility disorder to provide guidance for its clinical prevention and control.METHODS A total of 468 patients with T2DM admitted to our hospital from October 2022 to April 2023 were selected to analyze the incidence of gastrointestinal motility disorder.Logistic regression analysis was used to identify the influencing factors of gastrointestinal motility disorder in T2DM patients.A nomogram prediction model for gastrointestinal motility disorder was established,and the clinical utility of the model was evaluated using receiver operating characteristic(ROC)curve analysis,calibration curve analysis,and decision curve analysis(DCA).RESULTS In 468 patients with T2DM,the incidence of gastrointestinal motility disorders was 44.84%.Decreased gastric motility(odds ratio[OR]=4.553,P<0.05),retinopathy(OR=4.676,P<0.05),peripheral neuropathy(OR=3.652,P<0.05),fasting plasma glucose(FPG)(OR=5.775,P<0.05),2-hour postprandial glucose(2hPG)(OR=3.627,P<0.05),hemoglobin A1c(HbAlC)(OR=5.792,P<0.05),gastrointestinal symptom rating scale(GSRS)score(OR=3.939,P<0.05),Hamilton Depression Scale(HAMD)score(OR=3.545,P<0.05),Hamilton Anxiety Scale(HAMA)score(OR=4.108,P<0.05),diabetes duration(OR=6.384,P<0.05),and body mass index(BMI)(OR=3.809,P<0.05)were identified to be independent risk factors for gastrointestinal motility disorders in patients with T2DM.ROC curve analysis showed that the sensitivity and specificity of the nomogram model for predicting gastrointestinal motility disorder in patients with T2DM were 82.36%and 96.47%,respectively.Calibration curve analysis and DCA suggested that the predicted probability values of the nomogram model and the actual values were basically linearly correlated,and the actual curve was basically coincident with the ideal curve.The nomogram had good clinical applicability in predicting gastrointestinal motility disorders in patients with T2DM.CONCLUSION Patients with T2DM are at risk of gastrointestinal motility disorder,and factors such as decreased gastric motility,retinopathy,peripheral neuropathy,FPG,2hPG,HbAlc,GSRS score,HAMD score,HAMA score,diabetes duration,and BMI are risk factors for gastrointestinal motility disorder in patients with T2DM.The predictive model constructed in this study can help screen and identify high-risk populations,providing guidance for the clinical prevention and inter-vention of gastrointestinal motility disorder in patients with T2DM.