青岛糖尿病危险评分表筛查2型糖尿病效果评价

曹怡; 宁锋; 孙健平; 崔静; 李晓静; 逄增昌

doi:10.11847/zgggws2016-32-07-07

青岛糖尿病危险评分表筛查2型糖尿病效果评价

Efficacy of Qingdao diabetes risk score in type 2 diabetes mellitus screening among asymptomatic adult populations

摘要

摘要: 目的评价青岛糖尿病危险评分表（QDRS）筛查2型糖尿病（T2DM）的效果，为T2DM的预防控制提供参考依据。方法对山东省青岛市2009年糖尿病项目中自报无T2DM的4 426人进行口服葡萄糖耐量试验（OGTT），于2012年对其中3 843名未患T2DM者进行随访调查，通过构建受试者工作特征曲线（ROC）模型，比较QDRS与空腹血浆血糖（FPG）和中国糖尿病危险评分表（CDRS）筛查无症状T2DM人群的灵敏度、特异度和约登指数，并在2 295名3年随访人群中验证该工具的可靠性。结果青岛市2009年4 426名基线人群的T2DM发病率为13.2%，2012年2 295名随访人群的T2DM发病率为7.9%；2009年FPG、QDRS和CDRS筛查T2DM的曲线下面积（AUC）分别为0.87（95%CI=0.85~0.89）、0.68（95%CI=0.66~0.70）和0.70（95%CI=0.68~0.72），最佳切点（FPG≥6.4 mmol/L、QDRS≥14分和CDRS≥30分）的灵敏度分别为72.0%、73.2%和66.2%，特异度分别为91.2%、66.5%和63.8%，约登指数分别为0.63、0.30和0.30；2012年FPG、QDRS和CDRS筛查T2DM的AUC分别为0.83（95%CI=0.79~0.87）、0.62（95%CI=0.57~0.66）和0.65（95%CI=0.61~0.70），最佳切点的灵敏度分别为51.7%、75.6%和73.8%，特异度分别为95.7%、41.0%和47.9%，约登指数分别为0.47、0.12和0.21；2009年和2012年QDRS与FPG、CDRS预测新发糖尿病效能比较，差异均无统计学意义（均P > 0.05）。结论 QDRS可以作为预测T2DM人群的可靠筛查工具。

Abstract: Objective To evaluate the efficacy of Qingdao diabetes risk score (QDRS) in type 2 diabetes mellitus (T2DM) screening among symptomatic adult residents and to provide references for T2DM prevention and control. Methods A diabetes control project was conducted among 4 426 self-assessed healthy persons aged 35-74 years in Qingdao city of Shandong province;questionnaire surveys including Chinese diabetes risk score (CDRS), QDRS and a general questionnaire, physical examination, and laboratory test including oral glucose tolerance test (OGTT) and fasting plasma glucose (FPG) were performed among the attendees of the project.Then a follow-up study the same as the previous project was conducted in 2012 among 3 843 attendees who were not diagnosed with T2DM in 2009, of which, 2 295 were followed up finally.Receiver operating characteristic (ROC) curve was constructed and the sensitivity, specificity, and Youden indexe were calculated for QDRS, CDRS, and FPG to evaluate the efficacy of the indexes in screening asymptomatic diabetes. Results The detection rate of T2DM was 13.2% among the 4 426 participants of the survey in 2009 and 7.9% among the 2 295 participants of follow-up study in 2012.Based on the data of 2009 survey, the area under the ROC curve (AUC) of FPG, QDRS, and CDRS for T2DM detection were 0.87 (95% confidence interval95%CI=0.85-0.89), 0.87 (95%CI=0.85-0.89), and 0.70 (95%CI=0.68-0.72);the sensitivity and specificity of the optimal cut-off value of FPG (≥6.4 mmol/L), QDRS (≥14 points), and CDRS (≥30 points) were 72.0% and 91.2%, 73.2% and 66.5%, and 66.2% and 63.8%, respectively;the Youden' index for FPG, QDRS, and CDRS were 0.63, 0.30, and 0.30.Based on the data of 2012 follow-up study, the AUC of FPG, QDRS, and CDRS were 0.83 (95%CI=0.79-0.87), 0.62 (95%CI=0.57-0.66), and 0.65 (95%CI=0.61-0.70);the sensitivity and specificity of the optimal cut-off value of FPG, QDRS, and CDRS were 51.7% and 95.7%, 75.6% and 41.0%, and 73.8% and 47.9%, respectively;the Youdenindex for FPG, QDRS, and CDRS were 0.47, 0.12, and 0.21.There were no significant differences in the efficacy of QDRS and FPG, CDRS for predicting T2DM incidence between 2009 survey and 2012 follow-up study(P > 0.05 for all). Conclusion QDRS could be used as a reliable screening tool for T2DM screening among healthy adult populations.

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