心血管病风险预测模型在2型糖尿病人群中的验证

梁靖媛; 李倩倩; 刘晓非; 王佳敏; 沈鹏; 林鸿波; 唐迅; 高培

doi:10.16016/j.1000-5404.202101028

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心血管病风险预测模型在2型糖尿病人群中的验证

专题报道：常见慢性非传染性疾病的预防与控制 | 更新时间：2026-01-09

- 心血管病风险预测模型在2型糖尿病人群中的验证
- Cardiovascular disease risk prediction models for type 2 diabetes: verification in Chinese patients
- 第三军医大学学报 2021年43卷第12期页码：1097-1102
- 作者机构：
  
  1.北京，北京大学：公共卫生学院流行病与卫生统计学系
  2.北京，北京大学：临床研究所真实世界证据评价中心
  3.315100 浙江宁波，宁波市鄞州区疾病预防控制中心
  4.100191 北京，分子心血管学教育部重点实验室
- 作者简介：
  
  [高培，E-mail: peigao@bjmu.edu.cn GAO Pei, E-mail: peigao@bjmu.edu.cn
- 基金信息：
  
  国家自然科学基金(81961128006);国家自然科学基金(81973132);国家重点研发计划(2020YFC2003503)
- DOI：10.16016/j.1000-5404.202101028
  中图分类号： R181.3;R54;R587.1
- 收稿：2021-01-04，
  
  修回：2021-02-10，
  
  纸质出版：2021-06-30
- 稿件说明：
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梁靖媛, 李倩倩, 刘晓非, 等. 心血管病风险预测模型在2型糖尿病人群中的验证[J]. 第三军医大学学报, 2021,43(12):1097-1102.

Jingyuan LIANG, Qianqian LI, Xiaofei LIU, et al. Cardiovascular disease risk prediction models for type 2 diabetes: verification in Chinese patients[J]. Journal of Third Military Medical University, 2021, 43(12): 1097-1102.
梁靖媛, 李倩倩, 刘晓非, 等. 心血管病风险预测模型在2型糖尿病人群中的验证[J]. 第三军医大学学报, 2021,43(12):1097-1102. DOI： 10.16016/j.1000-5404.202101028.

Jingyuan LIANG, Qianqian LI, Xiaofei LIU, et al. Cardiovascular disease risk prediction models for type 2 diabetes: verification in Chinese patients[J]. Journal of Third Military Medical University, 2021, 43(12): 1097-1102. DOI： 10.16016/j.1000-5404.202101028.

摘要

目的

在我国2型糖尿病人群中独立验证并比较美国弗明汉(Framingham)心血管病预测模型和新西兰糖尿病队列研究(diabetes cohort study

DCS)心血管病预测模型的准确性。

方法

研究对象为2010年1月1日至2018年12月31日在中国鄞州电子健康档案研究项目中有医疗记录的48 063名基线时未患有心血管病的30~74岁2型糖尿病患者。采用Kaplan-Meier方法计算研究对象5年心血管病实际发病风险，采用再校准后的Framingham模型和DCS模型分别计算研究对象5年心血管病的预测风险。采用C统计量评价模型的区分度，Hosmer-Lemeshow卡方值和校准图评价模型的校准度。

结果

经过中位5.9年的随访，48 063名研究对象中共出现2 867例新发心血管病事件。Framingham模型和DCS模型均低估了研究对象的发病风险，在男性中分别低估了3.6%和21.1%，而在女性中则分别低估了21.0%和20.9%。在男性中，DCS模型的区分度优于Framingham模型，两模型的C统计量和95%可信区间分别为0.716(0.702~0.730)和0.662(0.648~0.677)；但校准度方面两模型表现均不理想(

0.05)。在女性中DCS模型和Framingham模型的C统计量和95%可信区间分别为0.743(0.730~0.756)和0.686(0.673~0.700)，校准度均较差(

0.05)。

结论

Framingham模型和DCS模型不适用于我国2型糖尿病人群心血管病风险预测。

Abstract

Objective

To independently verify and compare the accuracy of 2 cardiovascular risk prediction models

Framingham model and New Zealand Diabetes Cohort Study (DCS) model in Chinese patients with type 2 diabetes mellitus (T2DM).

Methods

A total of 48 063 T2DM patients aged from 30 to 74 who had medical records but no cardiovascular diseases (CVD) in the Chinese electronic health records research in Yinzhou (CHERRY) were enrolled from January 1

2010 to December 31

2018. Kaplan Meier method was used to calculate the actual risk of CVD in following 5 years

and the recalibrated Framingham model and DCS model were adopted to estimate the predicted 5-year risks of the diseases. The performance of the models was assessed in terms of discrimination and calibration degrees

using C-index and Hosmer-Lemeshow

Chi

-square value respectively.

Results

Through a median follow-up of 5.9 years

2 867 new CVD cases were observed among the subjects. However

both the Framingham and the DCS models underestimated the risk of subjects

by 3.6% (Framingham) and 21.1% (DCS) in males

and by 21.0% (Framingham) and 20.9% (DCS) in females

respectively. For males

the DCS model (C-index=0.716

95%

: 0.702~0.730) had a better discriminative ability than the Framingham one (C-index=0.662

95%

: 0.648~0.677)

though the performance of calibration was not ideal in both models (

0.05). For females

C-index was 0.743 in DCS (95%

: 0.730~0.756) and 0.686 in Framingham models (95%

: 0.673-0.700)

both showing poor performance on calibration (

0.05).

Conclusion

Both Framingham model and DCS model are confirmed inapplicable to CVD risk prediction in Chinese population with T2DM.

关键词

Keywords

references

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