Christianson Teresa J H, Bryant Sandra C, Weymiller Audrey J, Smith Steven A, Montori Victor M
Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Mayo Clin Proc. 2006 May;81(5):632-6. doi: 10.4065/81.5.632.
To develop a pen-and-paper coronary heart disease (CHD) 10-year risk estimator for patients with type 2 diabetes based on the United Kingdom Prospective Diabetes Study (UKPDS) risk equation (based on 4000 patients with diabetes but only available electronically).
We used data collected from adults with type 2 diabetes from 6 primary care practices that participated in a randomized trial in Rochester, Minn; patients were enrolled in the study from July 2001 to December 2003, with follow-up through June 2004. We used multivariable linear regression of the CHD risk estimate to formulate prediction equations to estimate average (<15%), elevated, or high (>30%) 10-year CHD risk according to sex, age, diabetes duration, smoking, hemoglobin A1c level, systolic blood pressure, ratio of total cholesterol to high-density lipoprotein cholesterol, and microalbuminuria categories. We selected cut points for the predicted score, seeking to (1) maximize the number of patients with total agreement between our estimator and the UKPDS risk equation, (2) avoid any patient's risk being either overestimated or underestimated by 2 risk categories, and (3) overestimate rather than underestimate coronary risk.
A total of 535 patients with type 2 diabetes participated in this study, 400 in the generation cohort and 135 in the validation cohort. Of the 400 patients in the generation cohort, our estimator had an 82% total agreement with the UKPDS calculation, 11% overestimated risk, and 7% underestimated UKPDS coronary risk (weighted kappa=0.77). Results were similar in the 135 patients in the validation cohort (kappa=0.79) and in an independent validation cohort of 52 patients attending a referral diabetes clinic (kappa=0.68).
The pen-and-paper estimator facilitates the point-of-care estimation of coronary risk in situations in which use of a desktop or handheld version of the electronic UKPDS risk engine is not practical or feasible. In our experience, estimation of risk using this tool, when done with patients, can further patients' insight into their risk of coronary events, often leading to enlightened discussions about modification of Individual risk factors.
基于英国前瞻性糖尿病研究（UKPDS）风险方程（基于4000例糖尿病患者，但仅以电子形式提供），开发一种用于2型糖尿病患者的纸笔式冠心病（CHD）10年风险评估工具。
我们使用了从明尼苏达州罗切斯特市6家初级保健机构中参与一项随机试验的2型糖尿病成年患者收集的数据；患者于2001年7月至2003年12月纳入研究，并随访至2004年6月。我们对CHD风险估计值进行多变量线性回归，以制定预测方程，根据性别、年龄、糖尿病病程、吸烟情况、糖化血红蛋白水平、收缩压、总胆固醇与高密度脂蛋白胆固醇比值以及微量白蛋白尿类别，估计10年CHD风险为平均（<15%）、升高或高（>30%）。我们为预测分数选择切点，旨在：（1）使我们的评估工具与UKPDS风险方程完全一致的患者数量最大化；（2）避免任何患者的风险被高估或低估2个风险类别；（3）高估而非低估冠心病风险。
共有535例2型糖尿病患者参与本研究，400例在生成队列，135例在验证队列。在生成队列的400例患者中，我们的评估工具与UKPDS计算结果的完全一致率为82%，风险高估11%，UKPDS冠心病风险低估7%（加权kappa=0.77）。验证队列的135例患者（kappa=0.79）以及转诊糖尿病诊所的52例独立验证队列患者（kappa=0.68）的结果相似。
在无法使用台式或手持式电子UKPDS风险引擎的情况下，纸笔式评估工具便于在医疗现场对冠心病风险进行评估。根据我们的经验，与患者一起使用该工具进行风险评估，可以增进患者对自身冠心病事件风险的了解，常常会引发关于个体风险因素调整的深入讨论。
