列线图预测北京社区成年人2型糖尿病风险的研究  

Study on nomograph predicting the risk of type 2 diabetes mellitus in Beijing community adults

作　　者：柳洪宙[1] 王安平[1] 王雅静 杜锦[1] 谷伟军[1] 吕朝晖[1] 窦京涛[1] 母义明[1] Liu Hongzhou;Wang Anping;Wang Yajing;Du Jin;Gu Weijun;Lyu Zhaohui;Dou Jingtao;Mu Yiming(Department of Endocrinology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心内分泌科,北京100853

出　　处：《中华内科杂志》2023年第1期54-60,共7页Chinese Journal of Internal Medicine

基　　金：国家重点研发项目(2018YFC1314103)。

摘　　要：目的构建预测成年人4年后2型糖尿病(T2DM)发病风险的列线图并进行验证。方法前瞻性队列研究。于2011年12月至2012年4月在北京市石景山区苹果园社区年龄≥40岁且无T2DM的成年人中进行基线调查, 4年后进行随访调查。最后共纳入8 058名受试者, 使用随机数字表法按照7∶3的比例分成建模组和验证组。采用单因素和多因素Cox比例风险模型确定建模组发生T2DM的独立危险因素, 并根据多因素分析的结果构建列线图, 用C指数和校准图评估列线图在建模组和验证组中预测4年发生T2DM风险的区分度和校准度。结果基线调查无T2DM的5 641名建模组受试者和2 417名验证组受试者4年后随访时分别有265例和106例发生T2DM。建模组Cox回归多因素分析显示年龄(HR=1.349, 95%CI 1.011~1.800)、体重指数(HR=1.347, 95%CI 1.038~1.746)、高脂血症(HR=1.504, 95%CI 1.133~1.996)、空腹血糖(HR=4.189, 95%CI 3.010~5.830)、糖负荷后2 h血糖(HR=3.005, 95%CI 2.129~4.241)、糖化血红蛋白(HR=3.162, 95%CI 2.283~4.380)、γ-谷氨酰转移酶(HR=1.920, 95%CI 1.385~2.661)是T2DM发生的独立危险因素。根据独立危险因素构建的列线图经验证显示, 建模组和验证组C指数分别为0.906(95%CI 0.888~0.925)和0.844(95%CI 0.796~0.892)。校准图显示, T2DM的估计概率与实际观测概率之间具有良好的一致性。结论构建的列线图是预测成年人4年患T2DM风险的简单可靠工具, 便于早期识别高危人群。Objective Development and validation of a nomogram for predicting the 4-year incidence of type-2 diabetes mellitus(T2DM)in a Chinese population was attempted.Methods This prospective cohort study was conducted in Shijingshan District Pingguoyuan Community(Beijing,China)from December 2011 to April 2012 among adults aged≥40 years not suffering from T2DM.Finally,8058 adults free of T2DM were included with a median duration of follow-up of 4 years.Participants were divided into a modeling group and verification group using simple random sampling at a ratio of 7∶3.Univariate and multivariate Cox proportional risk models were applied to identify the independent risk predictors in the modeling group.A nomogram was constructed to predict the 4-year incidence of T2DM based on the results of multivariate analysis.The Concordance Index and calibration plots were used to evaluate the differentiation and calibration of the nomogram in both groups.Results A total of 5641 individuals were in the modeling group and 2417 people were in the validation group,of which 265 and 106 had T2DM,respectively,at 4-year follow-up.In the modeling group,age(HR=1.349,95%CI 1.011-1.800),body mass index(HR=1.347,95%CI 1.038-1.746),hyperlipidemia(HR=1.504,95%CI 1.133-1.996),fasting blood glucose(HR=4.189,95%CI 3.010-5.830),2-h blood glucose level according to the oral glucose tolerance test(HR=3.005,95%CI 2.129-4.241),level of glycosylated hemoglobin(HR=3.162,95%CI 2.283-4.380),and level ofγ-glutamyl transferase(HR=1.920,95%CI 1.385-2.661)were independent risk factors for T2DM.Validation of the nomogram revealed the Concordance Index of the modeling group and validation group to be 0.906(95%CI 0.888-0.925)and 0.844(95%CI 0.796-0.892),respectively.Calibration plots showed good calibration in both groups.Conclusion These data suggest that our nomogram could be a simple and reliable tool for predicting the 4-year risk of developing T2DM in a high-risk Chinese population.

关 键 词：列线图 糖尿病 2型 危险因素 前瞻性研究 队列研究 C指数 

分 类 号：R587.1[医药卫生—内分泌]