ADVANCE心脑血管风险评估模型应用于上海2型糖尿病患者的价值和意义.docVIP

ADVANCE心脑血管风险模型应用于上海2型糖尿病患者的价值和意义 第二军医大学附属长征医院内分泌科 孟祥英 周勇 汤玮 宋艳 刘浩琪 倪奇 夏晓玲 陆燕蓉 史小燕 石勇铨 通讯作者：石勇铨 上海长征医院内分泌科young.stone@163.com 【摘要】目的：应用ADVANCE心脑血管风险模型评价上海2型糖尿病患者心脑血管患病风险的价值和意义。方法：采用回顾性队列研究，随机抽取上海市长桥社区420名2型糖尿病患者，评估终点事件为非致死性心肌梗死、非致死性中风或因心脑血管疾病死亡。使用Kaplan-Meier方法计算心脑血管实际发生风险，应用ADVANCE心脑血管风险模型预测发生心脑血管疾病发生风险，一致性指数评价该模型预测病人在研究期间出现终点事件的能力，Hosmer-Lemeshow χ2方法验证模型预测值和实际观测值的拟合优度。结果：研究中位随访期3.8年，共51名患者发生了终点心脑血管事件，实际发病风险为13.6%；但通过ADVANCE风险模型预测该人群终点心脑血管事件的风险为2.17%，模型一致性指数为0.753（95%CI：0.682-0.824），拟合优度为HLχ2=12.517（P =0.186）。结论：应用ADVANCE心脑血管风险模型显著低估上海地区人群2型糖尿病患者心脑血管疾病的发病风险，ADVANCE心脑血管风险模型可能不适用于上海地区人群2型糖尿病患者心脑血管疾病的发病风险，，需要重新校正该模型风险因素。 【关键词】 ADVANCE；2型糖尿病；心脑血管风险模型 【Abstract】Objective: To evaluate the value and significance for cardio-cerebrovascular diseases risk of type 2 diabetes by using the ADVANCE cardiovascular risk model in Shanghai area. Methods: A retrospective cohort study was conducted based on randomly selected the 420 patients with type 2 diabetes patients from the Changqiao community in Shanghai, and study endpoints were nonfatal myocardial infarction, stroke or death from cardiovascular causes. Kaplan-Meier method was used to calculate the actual rate of cardiovascular risk, the ADVANCE model to predict the risk of cardiovascular events, consistency index to evaluate the predictive ability of the model in patients with actual endpoint, and Hosmer-Lemeshow χ2 method to validate the goodness of fit between the model predictive value and the actual observed values. Results: Fifty-one patients occurred cardiovascular events during the median follow-up period of 3.8 years. The actual 4-year incidence rate of cardiovascular events was 19.6%, whereas the predictive risk rate of the cardiovascular end point events was 2.17% by ADVANCE risk model. The Model consistency index is 0.753 (95% CI: 0.682-0.824), and the goodness of fit is 12.517 (P = 0.186).Conclusions: the ADVANCE cardiovascular risk model may not apply to cardio-cerebrovascular risk with type 2 diabetes in the Sh