2型糖尿病患者泛血管疾病风险预测模型的构建及验证

doi:10.3761/j.issn.0254-1769.2025.21.010

摘要/Abstract

摘要：

目的构建2型糖尿病（type 2 diabetes mellitus，T2DM）患者泛血管疾病风险预测模型，绘制列线图并验证模型的预测效果，为临床护理人员识别T2DM泛血管疾病高危患者提供依据。方法采用便利抽样法，于2024年1—8月选取大连市某三级甲等综合医院内分泌科、心内科、神经内科、神经外科、血管外科、介入科的520例T2DM患者作为调查对象，其中，2024年1—4月的360例为建模组，2024年5—8月的160例为验证组。应用T2DM患者泛血管疾病危险因素调查表收集一般资料及疾病相关资料，通过单因素分析和多因素Logistic回归分析探讨T2DM患者泛血管疾病的影响因素，建立风险预测模型，绘制列线图，通过受试者工作特征（receiver operator characteristic，ROC）曲线下面积、Hosmer-Lemeshow对该模型进行效度和拟合度的检验，采用约登指数确定模型的最佳截断值，通过临床决策分析曲线评价模型的预测效果。结果最终建模组纳入354例、验证组纳入160例。Logistic回归分析结果显示，BMI、糖尿病病程、高血压、既往心血管疾病病史、血脂异常、糖化血红蛋白、颈动脉斑块是T2DM患者泛血管疾病的影响因素（P<0.05）。Hosmer-Lemeshow检验结果显示，χ²=2.615，P=0.956。外部验证结果显示，最大约登指数为0.586，模型灵敏度为0.807，特异度为0.779，ROC曲线下面积为0.863。结论该研究构建的T2DM患者泛血管疾病风险预测模型具有良好的预测效能，可为医护人员早期识别和筛查T2DM泛血管疾病高风险患者提供科学依据。

关键词: 2型糖尿病, 泛血管疾病, 危险因素, 风险预测模型, 护理

Abstract:

Objective A risk prediction model for pan-vascular disease in patients with type 2 diabetes mellitus was constructed，and the nomogram was drawn and the prediction effect of the model was verified，so as to provide a basis for clinical nurses to identify patients at high risk of pan-vascular disease with T2DM. Methods Using the convenience sampling method，520 patients with Type 2 diabetes mellitus（T2DM） were selected as study participants from the endocrinology，cardiology，neurology，neurosurgery，vascular surgery，and interventional medicine departments of a tertiary A general hospital in Dalian between January and August 2024. Among these，360 participants from January to April 2024 constituted a modeling group，while 160 participants from May to August 2024 formed a validation group. The questionnaire on risk factors of pan-vascular disease in patients with T2DM was used to collect general data and disease-related data，and the influencing factors of pan-vascular disease in patients with T2DM were analyzed by univariate analysis and multivariate logistic regression. Hosmer-Lemeshow was used to test the validity and fit of the model；the Youden index was used to determine the optimal cut-off value of the early warning model；the clinical decision curve graph was used to analyze the clinical utility of the prediction model. Results Ultimately，354 cases were included in the modeling group and 160 cases in the validation group. Logistic regression analysis showed that BMI，duration of diabetes，hypertension，history of previous cardiovascular disease，dyslipidemia，glycosylated hemoglobin and carotid plaque were the risk factors for pan-vascular disease in patients with T2DM（P<0.05）. The results of Hosmer-Lemeshow test showed that χ²=2.615，P=0.956. The external validation results showed that the maximum approximate index was 0.586，the sensitivity of the model was 0.807，the specificity was 0.779，and the area under the ROC curve was 0.863. Conclusion This study establishes and validates a risk prediction model for generalized vascular disease in patients with T2DM，demonstrating good predictive efficacy. It provides a scientific basis for healthcare professionals to early identify and screen

Key words: Type 2 Diabetes, Pan-Vascular Disease, Risk Factors, Risk Prediction Model, Nursing Care

王品, 关红. 2型糖尿病患者泛血管疾病风险预测模型的构建及验证[J]. 中华护理杂志, 2025, 60(21): 2627-2634.

WANG Pin, GUAN Hong. Construction and validation of a risk prediction model for pan-vascular disease in patients with type 2 diabetes mellitus[J]. Chinese Journal of Nursing, 2025, 60(21): 2627-2634.

图/表 5

表1 调查对象的一般资料及泛血管疾病的单因素分析结果

Table 1 General information of the survey subjects and the results of univariate analysis of pan-vascular diseases

续表1 调查对象的一般资料及泛血管疾病的单因素分析结果

Table 1 （Continued） General information of the survey subjects and the results of univariate analysis of pan-vascular diseases

表2 自变量赋值方式

Table 2 Assignment methods for independent variables

表3 2型糖尿病患者泛血管疾病危险因素的多因素Logistic回归分析（n=354）

Table 3 Multivariate Logistic regression analysis of risk factors in patients with T2DM pan-vascular disease（n=354）

图1 2型糖尿病患者泛血管疾病风险预测模型的列线图

Figure 1 Nomogram of the risk prediction model for pan-vascular disease in patients with T2DM

参考文献 27

[1]	India State-Level Disease Burden Initiative Diabetes Collaborators. The increasing burden of diabetes and variations among the states of India:the global burden of disease study 1990-2016[J]. Lancet Glob Health, 2018, 6(12):e1352-e1362.
[2]	杨靖, 张英梅, 葛均波. 泛血管疾病防控——从疾病治疗到综合管理[J]. 中华心血管病杂志(网络版), 2021, 4(1):1-6.
	Yang J, Zhang YM, Ge JB. Prevention and control of pan-vascular diseases:from disease treatment to comprehensive management[J]. Chin J Cardiova Dis(Online Edition), 2021, 4(1):1-6.
[3]	朱晨玲, 兰美娟, 汤磊雯, 等. 浙江省护士对泛血管疾病护理知识和态度的调查研究[J]. 中华护理杂志, 2025, 60(10):1196-1201. DOI
	Zhu CL, Lan MJ, Tang LW, et al. A multicenter survey on the nurses’ knowledge and attitude of nursing for pan-vascular disease in Zhejiang Province[J]. Chin J Nurs, 2025, 60(10):1196-1201.
[4]	Sattar N, McMurray J, Borén J, et al. Twenty years of cardiovascular complications and risk factors in patients with type 2 diabetes:a nationwide Swedish cohort study[J]. Circulation, 2023, 147(25):1872-1886.
[5]	Hasbani NR, Westerman KE, Kwak SH, et al. Type 2 diabetes modifies the association of CAD genomic risk variants with subclinical atherosclerosis[J]. Circ Genom Precis Med, 2023, 16(6):e004176.
[6]	中国内分泌相关专家小组. 2型糖尿病患者卒中预防及血糖管理专家共识[J]. 中华内科杂志, 2024, 63(7):649-659.
	Expert Group on Endocrinology in China. Expert consensus on stroke prevention and blood glucose management in patients with type 2 diabetes[J]. Chin J Int Med, 2024, 63(7):649-659.
[7]	张艳, 徐蓉, 刘芳, 等. 糖尿病管理中护士的角色发展及展望[J]. 中华护理教育, 2023, 20(9):1038-1044.
	Zhang Y, Xu R, Liu F, et al. The development and prospect of the role of nurses in diabetes management in China[J]. Chin J Nurs Educ, 2023, 20(9):1038-1044.
[8]	北京大学医学系糖尿病肾脏病专家共识协作组. 糖尿病肾脏病诊治专家共识[J]. 中华医学杂志, 2020, 100(4):247-260.
	Expert Consensus Collaboration Group on Diabetic Nephropathy,Department of Health Peking University. Expert consensus on diagnosis and treatment of diabetic nephropathy[J]. Natl Med J Chin, 2020, 100(4):247-260.
[9]	Dong WN, Wan EYF, Fong DYT, et al. Prediction models and nomograms for 10-year risk of end-stage renal disease in Chinese type 2 diabetes mellitus patients in primary care[J]. Diabetes Obes Metab, 2021, 23(4):897-909. DOI PMID
[10]	蔡芬, 李利, 杨翠婷, 等. 预测2型糖尿病并发急性心力衰竭的列线图风险模型的建立与评估[J]. 循证护理, 2023, 9(8):1460-1465.
	Cai F, Li L, Yang CT, et al. Establishment and evaluation of Nomogram risk model for predicting type 2 diabetes mellitus complicated with acute heart failure[J]. Chin Evid Based Nurs, 2023, 9(8):1460-1465.
[11]	Viigimaa M, Sachinidis A, Toumpourleka M, et al. Macrovascular complications of type 2 diabetes mellitus[J]. Curr Vasc Pharmacol, 2020, 18(2):110-116. DOI PMID
[12]	葛均波, 翁建平, 曾强. 2型糖尿病患者泛血管疾病风险评估与管理中国专家共识(2022版)[J]. 中国循环杂志, 2022, 37(10):974-990.
	Ge JB, Weng JP, Zeng Q. Chinese expert consensus on the risk assessment and management of panvascular disease in patients with type 2 diabetes mellitus(2022 edition)[J]. Chin Circ J, 2022, 37(10):974-990.
[13]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)(上)[J]. 中国实用内科杂志, 2021, 41(8):668-695.
	Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China(2020 edition)(Part 1)[J]. Chin J Pract Intern Med, 2021, 41(8):668-695.
[14]	肖顺贞. 临床科研设计[M]. 北京: 北京大学医学出版社, 2003.
	Xiao SZ. Clinical scientific research design[M]. Beijing: Peking University Medical Press, 2003.
[15]	葛均波, 霍勇. 泛血管疾病防治策略与展望[J]. 中国介入心脏病学杂志, 2023, 31(1):1-54.
	Ge JB, Huo Y. Prevention and treatment strategies and prospects of pan-vascular diseases[J]. Chin J Int Cardiol, 2023, 31(1):1-54.
[16]	ElSayed NA, Aleppo G, Aroda VR, et al. 8. obesity and weight management for the prevention and treatment of type 2 diabetes:standards of care in diabetes-2023[J]. Diabetes Care, 2023, 46(Suppl 1):S128-S139.
[17]	Chen JH, Li YT, Niu ZM, et al. Investigating the causal association of generalized and abdominal obesity with microvascular complications in patients with type 2 diabetes:a community-based prospective study[J]. Diabetes Obes Metab, 2024, 26(7):2796-2810.
[18]	冯苏文, 赵春艳, 许方蕾. 糖尿病患者运动管理评价指标的研究进展[J]. 中华护理杂志, 2021, 56(11):1741-1746. DOI
	Feng SW, Zhao CY, Xu FL. Research progress of exercise management evaluation index in diabetic patients[J]. Chin J Nurs, 2021, 56(11):1741-1746. DOI
[19]	Dhamoon MS, Dong CH, Elkind MSV, et al. Ideal cardiovascular health predicts functional status independently of vascular events:the Northern Manhattan study[J]. J Am Heart Assoc, 2015, 4(2):e001322.
[20]	Wong ND, Sattar N. Cardiovascular risk in diabetes mellitus:epidemiology,assessment and prevention[J]. Nat Rev Cardiol, 2023, 20(10):685-695.
[21]	Jun HT, ARIMA H, Rothwell PM, et al. Effects of visit-to-visit variability in systolic blood pressure on macrovascular and microvascular complications in patients with type 2 diabetes mellitus:the ADVANCE trial[J]. Circulation, 2013, 128(12):1325-1334.
[22]	刘艳, 曾高峰. 骨标志物水平与2型糖尿病患者心血管疾病风险研究[J]. 中南医学科学杂志, 2020, 48(4):356-359.
	Liu Y, Zeng GF. Study of the bone markers and the risk of cardiovascular disease in patients with type 2 diabetes mellitus[J]. Med Sci J Cent South Chin, 2020, 48(4):356-359.
[23]	Gong L, Wang C, Ning G, et al. High concentrations of triglycerides are associated with diabetic kidney disease in new-onset type 2 diabetes in China:findings from the China cardiometabolic disease and cancer cohort(4C) study[J]. Diabe-tes Obes Metab, 2021, 23(11):2551-2560.
[24]	缪鋆鋆, 孙心怡, 贾佳, 等. 老年2型糖尿病肾病病人血脂与肾功能指标的变化[J]. 实用老年医学, 2021, 35(2):177-179.
	Miao JJ, Sun XY, Jia J, et al. Changes of blood lipid and renal function in elderly patients with type 2 diabetic nephropathy[J]. Pract Geriatr, 2021, 35(2):177-179.
[25]	陈宏. 多指标联合检测在糖尿病早期肾损伤诊断中的应用价值[J]. 检验医学与临床, 2021, 18(9):1311-1314.
	Chen H. Application value of multi-index combined detection in diagnosis of early renal injury in diabetes mellitus[J]. Lab Med Clin, 2021, 18(9):1311-1314.
[26]	刘景利, 白进川, 杜学成. 糖尿病肾病患者血清淀粉样蛋白A、胱抑素C和25-羟基维生素D水平与肾功能的关系[J]. 江苏医药, 2020, 46(6):604-607.
	Liu JL, Bai JC, Du XC. Relationship of serum amyloid A,cystatin C and 25-hydroxyvitamin D levels and renal function in patients with diabetic kidney disease[J]. Jiangsu Med J, 2020, 46(6):604-607.
[27]	Wu Y, He J, Sun X, et al. Carotid atherosclerosis and its relationship to coronary heart disease and stroke risk in patients with type 2 diabetes mellitus[J]. Medicine(Baltimore), 2017, 96(39):e8151.