| 摘要: |
| 目的 基于卫生部激素与发育重点实验室提出的糖尿病肾脏病(diabetic kidney disease, DKD)风险模型,建立列线图以识别2年内可能出现进展的高危DKD患者。方法 本研究是前瞻性队列研究,筛选符合DKD高风险标准的2型糖尿病患者并随访两年。随访期间进展为DKD的定义为DKD组,未出现进展的定义为非DKD组。通过单、多因素COX回归分析入选患者的基线临床资料和超声指标,建立列线图模型以预测DKD高风险患者2年内出现疾病进展的风险。结果 至随访结束,DKD组患者63例,非DKD组患者308例。生存分析显示DKD高风险患者2年内出现进展的比例为16.98%。多因素Cox回归分析发现,糖尿病病程、肾叶间动脉阻力指数、以及患者合并糖尿病视网膜病变和高血压是DKD高风险患者2年内疾病进展的独立影响因素(均P < 0.05)。基于这四项指标建立的列线图预测模型具有较好的区分度[曲线下面积(area under the curve, AUC)：0.783],其预测准确性高于各预测因子单独预测的AUC(P＜0.05)。此外,该列线图预测DKD进展的概率与实际发生率的一致性较好(χ2=6.392, P=0.592),且具有良好的净收益,表明其在临床决策方面具有良好的应用价值。结论 本研究建立了包含四项常见指标的列线图预测模型,用于识别2年内可能出现进展的高危DKD患者,从而在尿微量白蛋白升高前的“亚临床”阶段即实施早期干预,有望延缓甚至阻止高危患者进一步进展为DKD。 |
| 关键词: 糖尿病，糖尿病肾病，尿微量白蛋白，肾叶间动脉，列线图 |
| DOI： |
| 投稿时间：2023-03-28修订日期：2023-04-18 |
| 基金项目: |
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| Nomogram predicting the risk of disease progression within 2 years in diabetic patients at high risk of developing diabetic kidney disease |
| Feng Zhao,Tao Zhang,Wei Zhang,Ying Ding,Wenjuan Yan |
| (Department of ultrasound,Shanghai Pudong New Area Guangming Traditional Chinese Medicine Hospital) |
| Abstract: |
| Objective To establish a nomogram based on the risk model of diabetic kidney disease (DKD) proposed by National Health Commission Key Laboratory of Hormones and Development, in order to identify high-risk DKD patients who may experience progression within two years. Methods This study was a prospective cohort study that selected patients with type 2 diabetes mellitus who met the high-risk criteria for DKD and followed them for two years. Patients who experienced DKD progression during the follow-up period were defined as the DKD group, while those who did not were defined as the non-DKD group. Clinical baseline data and ultrasound indicators of the selected patients were analyzed using uni- and multi-variate Cox regression analysis, and a nomogram model was established to predict the risk of disease progression in high-risk DKD patients within two years. Results By the end of the follow-up, there were 63 patients in the DKD group and 308 patients in the non-DKD group. Survival analysis showed that the proportion of high-risk DKD patients who experienced progression within 2 years was 16.98%. Multivariate Cox regression analysis found that the duration of diabetes, interlobar resistance index, and the presence of diabetic retinopathy and hypertension were independent factors influencing disease progression in high-risk DKD patients within 2 years (all P < 0.05). The nomogram model based on these four indicators had good discrimination (area under the curve, AUC: 0.783), and its predictive accuracy was higher than that of each individual predictor alone (P < 0.05). In addition, the probability of DKD progression predicted by the nomogram was consistent with the actual incidence (χ2=6.392, P=0.592), and it had a good net benefit, indicating its good clinical application value in decision-making. Conclusion This study established a nomogram incorporating four common indicators to identify high-risk DKD patients who may progress within two years, enabling early intervention during the "subclinical" stage before urinary microalbuminuria elevation. This nomogram had the potential to delay or even prevent high-risk patients from further progressing to DKD. |
| Key words: Diabetes, Diabetic kidney disease, Urinary microalbumin, Renal interlobar artery, Nomogram |
