四川遂宁地区2型糖尿病患者并发冠心病危险因素及风险模型构建  

Risk factors and risk model construction of coronary heart disease in patients with type 2 diabetes mellitus in Suining area

作　　者：何涛[1] 谭震 黄刚[1] 何小君[1] 邓学军[1] HE Tao;TAN Zhen;HUANG Gang;HE Xiaojun;DENG Xuejun(Department of Second Cardiovascular Centerward,Suining Central Hospital,Suining,Sichuan 629000,China)

机构地区：[1]四川省遂宁市中心医院心血管中心二病区,四川遂宁629000

出　　处：《公共卫生与预防医学》2023年第3期102-105,共4页Journal of Public Health and Preventive Medicine

基　　金：四川省基层卫生事业发展研究中心科研项目(SWFZ20-Q-058)。

摘　　要：目的分析遂宁地区2型糖尿病(T2M)患者发生冠心病发病的危险因素,并构建风险预测模型,为T2M患者防治冠心病提供理论依据。方法选取2021年1月至2021年12月来遂宁市中心医院治疗的T2M患者476例,根据患者是否患有冠心病分为实验组(n=79)和对照组(n=397),观察T2M合并冠心病患者冠状动脉病变的造影特点,统计所有患者年龄、性别、体质量指数(BMI)、吸烟、饮酒情况、T2M病程、FBG、FINS、HOMA、TC、LDL-C、SBP、DBP和UA等水平,采用单因素分析和logistic回归分析发生冠心病的影响因素,建立风险预测模型,采用ROC曲线对该模型效能进行预测。结果T2M患者合并冠心病79例中冠脉多支病64例(81.01%);冠脉轻度狭窄5例(6.33%)中度狭窄20例(25.32%)、重度狭窄54例(68.35%);实验组患者平均年龄、吸烟比例、BMI、T2M病程及FBG、FINS、HOMA、TC、LDL-C、SBP、DBP和UA水平显著高于对照组(P<0.05);多因素logistic回归分析,结果显示高龄、SBP升高、LDL-C升高、FBG升高是遂宁地区T2M患者发生冠心病的独立危险因素(OR=1.476、2.674、2.984、3.572,P<0.05);根据上述4个独立影响因素及各因素对应的回归系数,建立风险预测模型的表达式为P=1/[1+e-^((-0.513+0.919×(高龄)+1.129×(SBP升高)+1.724×(FBG升高)+1.529×(LDL-C升高))];采用ROC曲线对该回归模型预测效能进行分析,结果表明该风险预测模型预测T2M患者发生冠心病的AUC为0.728,95%CI(0.651~0.829)。结论遂宁地区T2M患者发生冠心病的风险较高,对于高龄、SBP升高、LDL-C升高、FBG升高的老年患者发生冠心病的风险较高,可通过预测模型评估发生冠心病的风险,给予针对性的干预措施,可降低T2M患者发生冠心病的风险。Objective To analyze the risk factors of coronary heart disease(CHD)in patients with type 2 diabetes mellitus(T2M)in Suining area,and build a risk prediction model to provide theoretical basis for the prevention and treatment of CHD in PATIENTS with T2M.Methods A total of 476 T2M patients treated in our hospital from January 2021 to December 2021 were selected and divided into experimental group(n=79)and control group(n=397)according to whether they had coronary heart disease.The angiographic characteristics of coronary artery lesions in patients with T2M combined with coronary heart disease were observed.Age,sex,body mass index(BMI),smoking,alcohol consumption,T2M course,FBG,FINS,HOMA,TC,LDL-C,SBP,DBP and UA levels of all patients were analyzed.Univariate analysis and Logistic regression were used to analyze the influencing factors of coronary heart disease and establish a risk prediction model.ROC curve was used to predict the efficiency of the model.Results A total of 79 cases(16.60%)of patients with T2M complicated with coronary heart disease,including 64 cases(81.01%)of patients with T2M complicated with coronary artery disease.Mild stenosis in 5 cases(6.33%),moderate stenosis in 20 cases(25.32%)and severe stenosis in 54 cases(68.35%);The mean age,smoking proportion,BMI,T2M course and the levels of FBG,FINS,HOMA-IR,TC,LDL-C,SBP,DBP and UA in experimental group were significantly higher than those in control group(P<0.05).Multivariate logistic regression analysis showed that advanced age,increased SBP,increased LDL-C,and increased FBG were independent risk factors for CORONARY heart disease in T2M patients in Suining area(OR=1.476,2.674,2.984,3.572,P<0.05).According to the above four independent factors and their corresponding regression coefficients,the expression of risk prediction model was P=1/[1+e-^((-0.513+0.919×(old age)+1.129×(increased SBP)+1.724×(increased FBG)+1.529×(increased LDL-C))].ROC curve was used to analyze the predictive performance of the regression model.The results showed that the A

关 键 词：2型糖尿病 冠心病 风险因素 预测模型 

分 类 号：R181[医药卫生—流行病学]