Chen X W, Liu L J, Yu Y X, Zhang M, Li P, Zhao H Y, Sun Y X, Sun H Y, Sun Y M, Liu X Y, Lin H B, Shen P, Zhan S Y, Sun F
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Hainan University, Haikou 570228, China Hainan Boao Lecheng International Medical Tourism Pilot Zone Administration, Hainan Real-World Data Research Institute, Lecheng 571437, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2024 Sep 10;45(9):1283-1290. doi: 10.3760/cma.j.cn112338-20240117-00023.
To develop a prediction model for the risk of diabetic retinopathy (DR) in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Patients with new diagnosis of T2DM recorded in Yinzhou Regional Health Information Platform between January 1, 2015 and December 31, 2022 were included in the study. The predictor variables were selected by using Lasso-Cox proportional hazards regression model. Cox proportional hazards regression models were used to establish the prediction model for the risk of DR. Bootstrap method (500 resamples) was used for internal validation, and the performance of the model was assessed by C-index, the receiver operating characteristic curve and area under the curve (AUC), and calibration curve. The predictor variables included in the final model were age of T2DM onset, education level, fasting plasma glucose, glycated hemoglobin A1c, urinary albumin, estimated glomerular filtration rate, and history of lipid-lowering agent and angiotensin converting enzyme inhibitor uses. The C-index of the final model was 0.622, and the mean corrected C-index was 0.623 (95%: 0.607-0.634). The AUC values for predicting the risk of DR after 3, 5, and 7 years were 0.631, 0.620, and 0.624, respectively, with a high degree of overlap of the calibration curves with the ideal curves. In this study, a simple and practical risk prediction model for DR risk prediction was developed, which could be used as a reference for individualized DR screening and intervention in newly diagnosed T2DM patients.
建立新诊断2型糖尿病(T2DM)患者糖尿病视网膜病变(DR)风险的预测模型。纳入2015年1月1日至2022年12月31日在鄞州区域健康信息平台记录的新诊断T2DM患者。通过Lasso-Cox比例风险回归模型选择预测变量。采用Cox比例风险回归模型建立DR风险预测模型。采用Bootstrap法(500次重采样)进行内部验证,并通过C指数、受试者工作特征曲线及曲线下面积(AUC)和校准曲线评估模型性能。最终模型纳入的预测变量包括T2DM发病年龄、教育水平、空腹血糖、糖化血红蛋白A1c、尿白蛋白、估计肾小球滤过率以及降脂药物和血管紧张素转换酶抑制剂使用史。最终模型的C指数为0.622,平均校正C指数为0.623(95%:0.607-0.634)。预测3年、5年和7年后DR风险的AUC值分别为0.631、0.620和0.624,校准曲线与理想曲线高度重叠。本研究建立了一种简单实用的DR风险预测模型,可为新诊断T2DM患者的个体化DR筛查和干预提供参考。