老年男性人群缺血性心脑血管病预测模型的建立  

Establishment of the prediction model for ischemic cardiovascular disease of elderly male population under current health care program

作　　者：陈金宏[1] 吴海云[2] 何昆仑[1] 何耀[1] 秦银河[1] 

机构地区：[1]武警总医院医务部,北京100039 [2]解放军总医院老年医学研究所

出　　处：《中华流行病学杂志》2010年第10期1166-1169,共4页Chinese Journal of Epidemiology

基　　金：基金项目：中央保健科研课题（06H050）;国家科技支撑计划（2009BA186801）;军队“十一五”课题（06L037）;首都医学发展基金重点项目（2007-2039）

摘　　要：目的 建立和验证老年人群缺血性心脑血管病（ICVD）预测模型.方法 统计分析来自某保健医院2003年5月的体检资料、历年住院资料、问卷调查资料和电话同访资料.按照4∶1的比例随机抽取基线人群,生成建模组和验证组.将验证人群基线资料代入建模人群的回归模型生成预测值.用ROC曲线下面积（AUC）检验预测模型的判别能力;用Hosmer-Lemeshow检验比较预测率每十分位分组的平均值和实际率来判断预测的准确性;将预测的6年ICVD发病风险的人群均值与实际观察到的6年累计患病率进行比较,计算误差率,验证预测模型群体水平的预测能力.结果 分析样本为2271名＞65岁男性老年人,建模人群1817人,验证人群454人.把年龄分为两层（≥75岁高龄组;＜75岁老龄组）建立分层Cox比例风险回归模型.老龄组有统计学意义的危险因素是年龄、SBP、血清肌酐（Scr）、空腹血糖（FBG）,保护因素是高密度脂蛋白胆固醇（HDL-C）;高龄组有统计学意义的危险因素是BMI、SBP、TC、Scr、FBG,保护因素是HDL-C.ROC的AUC及其95%CI为0.723（0.687～0.759）,将个体按预测ICVD累计患病率与实际患病率进行Hosmer-Lemshow检验：x2=1.43,P-0.786,模型群体水平预测误差率为-2.23%,能力较好.结论 建立的老年男性人群ICVD预测模型判别能力较好,个体预测能力和群体预测能力较为满意.Objective To establish and verify the prediction model for ischemic cardiovascular disease（ICVD）among the elderly population who were under the current health care programs. Methods Statistical analysis on data from physical examination, hospitalization of the past years, from questionnaire and telephone interview was carried out in May, 2003. Data was from was randomly selected to generate both module group and verification group. Baseline data was induced to make the verification group into regression model of module group and to generate the predictive value. Distinguished ability with area under ROC curve and the predictive veracity were verified through comparing the predictive incidence rate and actual incidence rate of every deciles group by Hosmer- Lemeshow test. Predictive veracity of the prediction model at population level was verified through comparing the predictive 6-year incidence rates of ICVD with actual 6-year accumulative incidence rates of ICVD with error rate calculated. Results The samples included 2271 males over the age of 65 with 1817 people for modeling population and 454 for verified population.All of the samples were stratified into two layers to establish hierarchical Cox proportional hazard regression model, including one advanced age group（greater than or equal to 75 years old）, and another elderly group（less than 75 years old）. Data from the statically analysis showed that the risk factors in aged group were age, systolic blood pressure, serum creatinine level, fasting blood glucose level, while protective factor was high density lipoprotein; in advanced age group, the risk factors were body weight index, systolic blood pressure, serum total cholesterol level, serum creatinine level, fasting blood glucose level, while protective factor was HDL-C. The area under the ROC curve （AUC）and 95%CI were 0.723 and 0.687-0.759 respectively. Discriminating power was good. All individual predictive ICVD cumulative incidence and actual incidence were analyzed using Hosmer-Lemshow

关 键 词：缺血性心脑血管病 老年人群 预测模型 

分 类 号：R54[医药卫生—心血管疾病] R743[医药卫生—内科学]