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目的构建新诊断的2型糖尿病患者5年内首次发生心脑血管事件的预测模型。方法研究对象选自青岛市黄岛区疾病预防控制中心慢性病管理系统,选择未发生过心脑血管事件的2型糖尿病患者2 899例作为训练样本,建立Cox模型和评分模型,并对模型进行内部验证;用“山东多中心健康管理纵向观察队列”中的1 016例2型糖尿病患者作为验证样本,对模型进行外部验证。结果随访期间训练样本共发生228例心脑血管事件,发病密度为16.86‰。模型变量包括年龄、性别、收缩压、低密度脂蛋白、高密度脂蛋白和心脑血管病家族史。训练样本Cox模型ROC曲线下面积(AUC)为0.678(95%CI:0.660~0.695),评分模型AUC为0.663(95%CI:0.648~0.680);外部验证Cox模型AUC为0.640(95%CI:0.608~0.676),评分模型AUC为0.631(95%CI:0.600~0.661)。结论研究建立的2型糖尿病患者心脑血管事件5年预测模型可以为社区糖尿病患者管理初期提供参考。
Objective To construct a predictive model of first occurrence of cardiovascular events in patients with newly diagnosed type 2 diabetes mellitus within 5 years. Methods The subjects were selected from chronic disease management system of Huangdao CDC in Qingdao. A total of 2 899 T2DM patients without cardiovascular events were selected as training samples to establish Cox model and scoring model. Validation; 1 016 cases of type 2 diabetes mellitus in “Shandong Multi-center Health Management Longitudinal Observation Cohort” were used as validation samples to verify the model externally. Results A total of 228 cardiovascular and cerebrovascular events occurred in the training samples during follow-up, with an incidence of 16.86 ‰. Model variables include age, gender, systolic blood pressure, low density lipoprotein, high density lipoprotein, and family history of cardiovascular and cerebrovascular diseases. The AUC of training Cox model was 0.678 (95% CI: 0.660-0.695), the AUC was 0.663 (95% CI: 0.648-0.680), the AUC of Cox model was 0.640 (95% CI: 0.608 ~ 0.676), the score model AUC was 0.631 (95% CI: 0.600 ~ 0.661). Conclusion The 5-year prediction model of cardiovascular and cerebrovascular events in patients with type 2 diabetes mellitus established in this study may provide a reference for the early management of community-based diabetes patients.