摘要
目的探讨社区中青年糖尿病前期发生的危险因素,建立并验证一种可视化评价工具辅助基层全科医师预测社区中青年糖尿病前期的发病风险。方法选择2021年6月至2023年8月新疆维吾尔自治区乌鲁木齐市某街道社区卫生服务中心进行健康体检的中青年糖尿病高危人群4307例为研究对象,其中糖尿病前期868名纳入糖尿病前期组,血糖水平正常3439名纳入血糖正常组。将研究对象按照7∶3的比例,分为训练集(3014名)和验证集(1293名)。分析训练集的临床资料,Lasso回归分析筛选独立预测因子,logistic回归分析社区中青年糖尿病前期发生的影响因素,建立社区中青年糖尿病前期的列线图风险预测模型,使用验证集对模型的可行性进行评估,受试者操作特征曲线、校正曲线和决策曲线分析评估列线图风险预测模型的鉴别能力、准确性及实用性。结果糖尿病前期组和血糖正常组的年龄、体重指数、腰围、吸烟史、高血压病、糖尿病家族史、丙氨酸转氨酶、天冬氨酸转氨酶、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、高尿酸血症、每日千步当量及饮酒比较,差异有统计学意义(P<0.05)。年龄、性别、高血压病、糖尿病家族史、高密度脂蛋白胆固醇、甘油三酯、腰围、每日千步当量和饮酒为筛选出的预测变量。年龄(OR=1.095)、高血压病(OR=5.781)、糖尿病家族史(OR=2.215)、高密度脂蛋白胆固醇降低(OR=4.190)、甘油三酯升高(OR=2.792)、腰围(OR=1.089)、饮酒(OR=3.368)是社区中青年糖尿病前期发生的危险因素(P<0.05),女性(OR=0.310)、每日千步当量(OR=0.641)为保护因素(P<0.05)。训练集和验证集中列线图风险预测模型预测社区中青年糖尿病前期发生的曲线下面积分别为0.888和0.870。列线图风险预测模型预测社区中青年糖尿病前期发生的拟合度较好。列线图风险预测模型预测社区中青年糖尿病前期发生的净收益较高。结论本研究成功建立一种高精度的社区中青年糖尿病前期发生的列线图风险预测模型,使基层全科医师在对社区中青年糖尿病前期高危人群的早期识别和筛选方面的能力得到一定程度的提升。
Objective To analyze the influencing factors of prediabetes in young and middle-aged people in community,and to establish and verify a visual evaluation tool to assist the grass-roots general practitioners to predict the onset risk of prediabetes in young and middle-aged people in community.Methods A total of 4307 young and middle-aged diabetes high-risk population who underwent physical examination at a community health service center in Urumqi,Xinjiang Uygur Autonomous Region from June 2021 to August 2023 were selected as the study subjects.Among them,868 people with prediabetes were included in prediabetes group and 3439 people with normal blood glucose were included in normal blood glucose group.They were divided into a training set(3014 people)and a validation set(1293 people)according to a ratio of 7∶3.The clinical data of training set were analyzed,the independent predictive factors were screened by Lasso regression analysis,and the influencing factors of the occurrence of prediabetes in young and middle-aged people in community were analyzed by logistic regression analysis,and a nomogram risk prediction model for prediabetes in young and middle-aged in community was established,validation set was used to evaluate feasibility of the model,and the discriminability,accuracy,and nomogram risk prediction model was evaluated by receiver operating characteristic curve,correction curve,and decision curve analysis.Results There were statistically significant differences in age,body mass index,waist circumference,smoking history,hypertension,family history of diabetes,alanine transaminase,aspartate transaminase,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,triglyceride,hyperuricemia,daily thousand step equivalent,and alcohol consumption between prediabetes group and normal blood glucose group(P<0.05).Age,sex,hypertension,family history of diabetes,high-density lipoprotein cholesterol,triglyceride,waist circumference,daily thousand step equivalent,and alcohol consumption were selected as predictor variable.Age(OR=1.095),hypertension(OR=5.781),family history of diabetes(OR=2.215),low high-density lipoprotein cholesterol(OR=4.190),elevated triglyceride(OR=2.792),waist circumference(OR=1.089),and alcohol consumption(OR=3.368)were risk factors of the occurrence of prediabetes in young and middle-aged people in community(P<0.05),female(OR=0.310),and daily thousand step equivalent(OR=0.641)were protective factors(P<0.05).The area under the curve of nomogram risk prediction model predicted the occurrence of prediabetes in young and middle-aged people in community of training set and validation set were 0.888 and 0.870,respectively.The nomogram risk prediction model predicted the occurrence of prediabetes in young and middle-aged people in community with a good fit.The nomogram risk prediction model predicted a higher net benefit for the occurrence of prediabetes in young and middle-aged people in community.Conclusion In this study,a high-precision nomogram risk prediction model for the occurrence of prediabetes in young and middle-aged people in community is successfully established,which improve the ability of grass-roots general practitioners in early identification and screening of high-risk prediabetes in young and middle-aged communities to some extent.
作者
刘芳
祖姆热提·阿布都克依木
马燕玲
王燕侠
李霞
LIU Fang;Zumureti Abudukeyimu;MA Yanling;WANG Yanxia;LI Xia(Department of General Practice,the Fifth Affiliated Hospital of Xinjiang Medical University,Xinjiang Uygur Autonomous Region,Urumqi830000,China)
出处
《中国医药导报》
CAS
2024年第14期25-31,共7页
China Medical Herald
基金
新疆维吾尔自治区“青年科技人才-乡村振兴”项目(WJWY-XCZ X202214)
新疆维吾尔自治区乌鲁木齐市卫生健康委科技计划项目(202257)。
关键词
糖尿病前期
中青年
风险
列线图
Prediabetes
Young and middle-aged
Risk
Nomogram
