ADVANCE心脑血管风险模型应用于上海市2型糖尿病患者的价值和意义  

Application of ADVANCE cardio-cerebrovascular risk model in patients with type 2 diabetes mellitus in Shanghai

作　　者：孟祥英[1] 周勇[1] 汤玮[1] 宋艳[1] 刘浩琪 倪奇[1] 夏晓玲[1] 陆燕蓉[1] 史小燕[1] 石勇铨[1] 

机构地区：[1]上海长征医院内分泌代谢科,上海200003

出　　处：《上海医学》2015年第3期226-230,共5页Shanghai Medical Journal

摘　　要：目的应用糖尿病和心血管病行动：培哚普利吲达帕胺（百普乐）与格列齐特（达美康）评价（actionindiabetesandvasculardisease：preteraxanddiamicron—mrcontrolledevaluation，ADVANCE）心脑血管风险模型评价上海市2型糖尿病患者心脑血管患病风险的价值和意义。方法随机抽取上海市长桥社区420例2型糖尿病患者，评估终点事件为非致死性心肌梗死、非致死性脑卒中或因心脑血管疾病死亡。采用Kaplan-Meier方法计算心脑血管实际发生风险，应用ADVANCE心脑血管风险模型预测心脑血管疾病的发生风险，一致性指数评价该模型预测患者在研究期间出现终点事件的能力，Hosmer-Lemeshowz。（HLx2）检验验证模型预测值与实际观测值的拟合优度。结果中位随访期为3．8年，51例患者发生了终点心脑血管事件，实际发病风险为13．6％，ADVANCE风险模型预测该人群终点心脑血管事件的风险为2．2％，拟合优度HLx2=12．517（P=0．186），一致性指数为0．753（95％CI为0．682～0．824）。结论ADVANCE心脑血管风险模型可能不适用于上海市2型糖尿病患者心脑血管疾病发病风险的预测，需要重新校正该模型的风险因素。Objective To evaluate the application of the action in diabetes and vascular disease： preterax and diamicron controlled evaluation （ADVANCE） cardiovascular risk model in patients with type 2 diabetes in Shanghai. Methods A retrospective cohort study was conducted in 420 patients with type 2 diabetes who were randomly selected from the Changqiao Community in Shanghai. Study endpoints included nonfatal myocardial infarction, nonfatal stroke or death from cardiovascular causes. Kaplan-Meier method was used to calculate the cardio-cerebrovascular risk. The ADVANCE model was used to predict the risk of cardio- cerebrovascular events. Consistency index was applied to evaluate the efficiency of the model in patients with actual endpoint, and Hosmer-Lemeshow X2 （HL X2） method was used to validate the goodness of fit between predictive value and actual observed values. Results Cardio-cerebrovascular events occurred in 51 patients during the median follow-up period of 3.8 years. The actua incidence of cardiovascular events was 13. 6%, whereas the predictive value of the model was 2.2%. The consistency index was 0. 753 （95% CI： 0. 682- 0. 824）, and the goodness of fit was 12. 517 （P = 0. 186）. Conclusion The ADVANCE model may not be suitable for the assessment of cardiovascular risk in type 2 diabetes in Shanghai. And it is necessary to adjust risk factors of the model.

关 键 词：2型糖尿病 ADVANCE 心脑血管风险模型 

分 类 号：R587.1[医药卫生—内分泌]