中国糖尿病风险评分在老年查体人群中应用的效果评价  

Evaluating the applied effectiveness of Chinese diabetes risk score in physical examination of elderly population

作　　者：王蕾蕾[1] 王建龙[2] 刘安楠[1] 杨书文[1] 张晏[1] 付静[1] 曹素艳[1] 

机构地区：[1]北京医院国家老年医学中心特需医疗部,100730 [2]北京医院泌尿外科,100730

出　　处：《中华老年医学杂志》2017年第7期806-810,共5页Chinese Journal of Geriatrics

摘　　要：目的分析中国糖尿病风险评分在老年体检人群中应用的效果，探讨老年体检人群糖代谢异常的危险因素。方法在1181例老年体检人群中进行糖尿病风险评分（CDRs）的筛查、糖耐量试验（（）GTT）、血生化指标、病史采集等。采用受试者工作特征曲线（ROC）的曲线下面积（AUC）反映筛查方法的准确度，用约登指数反映不同累计分值对目标人群筛检的效果；采用多因素logistic回归分析糖代谢异常者的相关危险因素。结果C-DRs筛查糖尿病的AUC为0．749（95％（CI：0．715～0．782），最佳切点值为32．5分时，敏感度86．50％，特异度60．84％，约登指数为0．47（P=0．000）；CDRs筛查糖尿病前期（包括糖耐量受损和空腹血糖受损）的Auc为0．760（95％CI：0．733t0．787），最佳切点值为33．5分时，敏感度70．89％，特异度68．72％，约登指数为0．40（P=0．000）;C-DRs筛查代谢综合征的AUc为0．797（95％CI：0．772～o．823），最佳切点值为32．5分时，敏感度83．62％，特异度64．90％，约登指数为0．49（P=0．000）；C-DRs筛查胰岛素抵抗的AUC为0．690（95％CI：0．645～0．734），最佳切点值为30．5分时，敏感度81．25％，特异度44．81％，约登指数为0．26（P=0．000）。多因素Logistic回归分析结果显示，年龄80岁及以上、腹型肥胖（体质指数≥28kg／m2，腰围：男性≥90cm、女性≥85cm）、高血压、高三酰甘油以及有糖尿病家族史是老年人糖代谢异常的危险因素（OR=1．557、1．543、1．495、1．569、1．625、1．715，均P〈0．05）。结论C-DRs适用于老年查体人群糖尿病、代谢综合征及胰岛素抵抗者的筛查；高龄、腹型肥胖、高血压、高i酰汁油、糖尿病家族史是老年人糖代谢异常的独立危险因素。Objective To analyze the effect of Chinese diabetes risk score in health checkup of elderly population and to explore the risk factors of abnormal glucose metabolism in the elderly patients. Methods Chinese diabetes risk score（C-DRs）screening,glucose tolerance test（oGTT）, blood biochemical parameters and history collection were performed in 1 181 elderly people participating the health checkup. The area under the ROC curve（AUC）was used to evaluate the accuracy of the screening method. The effect of different cumulative C-DRs on screening target population was reflected by the Gordon index. Multivariate logistic regression analysis was used to analyze relevant risk factors for the glucose metabolic abnormalities. Results The AUC of screening for diabetes was 0. 749 （ 95 % CI ： 0. 715-0. 782 ） , and the best cut-point value was 32.5 points. The sensitivity was 86.50%,the specificity was 60.84%,and the Gordon index was 0.47（P=0. 000）. The AUC of screening {or the pre-diabetes was 0. 760 （95%CI： 0. 733-0. 787）, and the best cut-point was 33.5 points. The sensitivity was 70.89%,the specificity was 68.72% ,and the Gordon index was 0.40 （P 〈0. 000）. The AUC of screening for MS was 0. 797（95% CI：0. 772-0. 823） ,and the best cut-point value was 32.5 points. The sensitivity was 83.62%,the specificity was 64.90%,and the Gordon index was 0.49（P=0. 000）. The AUC of screening for insulin resistance was 0. 609（95%CI：0. 645-0. 734）, and the best cut-point value was 30.5 points. The sensitivity was 81.25%, the specificity was44.81 % ,and the Gordon index was 0.26（P=0. 000）. Multiple logistic regression analysis showed that age over 80 years, abdominal obesity（waist circumference, male ≥90 cm, female ≥ 85 cm）, hypertension, hypertriglyceridemia, family history of diabetes were risk factors for abnormality of glucose metabolism in the elderly. The odd ratio values of the above were 1. 557,1. 543,1. 495,1. 569, 1. 625,1. 715 （all P%0.05）. Conclusions Chinese diabetes

关 键 词：糖尿病 多相筛查 危险因素 

分 类 号：R587.1[医药卫生—内分泌]