中老年居民动脉硬化自我筛查与基层医疗机构初筛工具构建  

Self⁃screening for arteriosclerosis in middle⁃aged and elderly residents and the construction of a primary care initial screening tool

作　　者：蒙玥 郑利 周静 王大珊 胡瑾[1] 汪蝶 李游 汪俊华[1] 王子云[1] MENG Yue;ZHENG Li;ZHOU Jing;WANG Dashan;HU Jin;WANG Die;LI You;WANG Junhua;WANG Ziyun(School of Public Health,the Key Laboratory of Environmental Pollution Monitoring and Disease Control,Ministry of Education,Guizhou Medical University,Guiyang 561113,China;不详)

机构地区：[1]贵州医科大学公共卫生与健康学院,环境污染与疾病监控教育部重点实验室,贵阳561113 [2]福泉市第一人民医院体检中心,贵州福泉550400

出　　处：《实用医学杂志》2024年第14期1947-1951,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金项目(编号:81960612);贵州省科技计划项目(编号:黔科合基础-ZK[2022]一般382)。

摘　　要：目的探索简便的动脉硬化初步筛查模型,为40~65岁居民早期识别动脉硬化风险,基层医疗机构改进动脉硬化筛查服务提供可行工具。方法数据来源于福泉市睡眠与慢性病研究的基线调查。按8:2的比例分为训练集与验证集,使用LASSO和logistic回归模型筛选变量、进行多因素回归分析,采用Bootstrap法进行内部验证。构建列线图模型,并根据ROC曲线确定风险评分阈值以划分高风险人群。结果居民初筛模型包括年龄、性别、午睡、睡眠效率、睡眠障碍及患高血压、糖尿病的情况,AUC为74.80%,模型风险评分阈值为84.20分。基层医疗机构初筛模型包括年龄、性别、午睡、睡眠效率、收缩压、空腹血糖、脉搏变量,AUC为82.80%,风险评分阈值为78.00分。决策曲线显示两个模型在健康管理实际获益方面表现良好。结论居民初筛模型、基层初筛模型两个模型准确性、区分度较好,可在居民自我健康管理和基层医疗机构初筛工作中推广应用。Objective To establish a simple model for arteriosclerosis(AS)screening to provide a viable tool for the timely identification of AS risk among residents aged 40~65 years.Methods Data were obtained from the Sleep and Chronic Diseases Program in Fuquan City.The original dataset was divided into a training subset and a validation subset(80%:20%).LASSO and logistic regression models were used to screen variables,perform multivariate regression analyses.Internal validation was performed using the Bootstrap method.Nomogram Plot was constructed,and risk score thresholds were determined based on ROC curves to classify high-risk populations.Results RS Model was established to include age,gender,napping,sleep efficiency,sleep disorders,hyperten⁃sion and diabetes,with AUC=74.80%and a model risk score threshold=84.20.PHC Model was established to include age,gender,napping,sleep efficiency,systolic blood pressure,fasting blood glucose,and pulse variables,with AUC=82.80%and a risk score threshold of 78.00.Decision curves showed that both models performed well in terms of calibration and actual benefits for health management.Conclusion The two AS screening models exhibit acceptable accuracy and differentiation.Therefore,it can be applied in residents'self-health management and in primary care organizations'screening work in a large scale.

关 键 词：动脉硬化 筛检模型 中老年人 列线图 基层医疗机构 

分 类 号：R181.22[医药卫生—流行病学]