健康管理人群慢性肾脏病风险预测模型

doi:10.6040/j.issn.1671-7554.0.2017.359

摘要/Abstract

摘要： 目的构建健康管理人群慢性肾脏病(CKD)发病风险预测模型。方法从山东多中心健康管理纵向观察队列中选取年龄20岁以上、至少有两次纵向观察结果、初次观察结果未患CKD的健康管理对象,共17 654人,随访观察结局为CKD。应用Cox比例风险回归模型建立风险预测模型,以受试者工作特征曲线下面积(AUC)评价模型的拟合效果,应用十折交叉验证法验证模型的稳定性。结果观察期间共有770例新发CKD病例,发病密度为17.69/1 000人年。最终纳入模型的预测因子有年龄、性别、高血压、糖尿病、血肌酐、血尿素氮、血尿酸、嗜碱性粒细胞百分比。模型AUC为0.685(95%CI:0.678~0.692),且稳定性较好。结论建立的CKD风险预测模型在健康管理人群中有较好的预测能力。

关键词: 风险预测模型, 慢性肾脏病, 健康管理, 队列

Abstract: Objective To establish a risk prediction model of chronic kidney disease(CKD). Methods The data were obtained from Shandong Multi-center Longitudinal Cohort for Health Management. A total of 17 654 subjects with age of 20 years or older were included who had no CKD at baseline and accepted health examination at least twice during the study period. The follow-up outcome was CKD. Cox proportional hazards regression was applied to establish the model and the predictive performance of the model was evaluated by AUC. Ten-fold cross validation was used to verify the stability of the model. Results A total of 770 cases were observed during the follow-up. The incidence density of CKD was 17.69 per thousand person-years. The predictive factors in the final model included age, sex, hypertension, diabetes, creatinine, blood urea nitrogen, uric acid and basophils percentage. The AUC of the model was 0.685(95%CI: 0.678-0.692). Conclusion We have constructed a risk model that could be useful for identifying individuals at high risk of CKD in health management population.

Key words: Chronic kidney disease, Risk prediction model, Health management, Cohort

中图分类号:

R692

周苗,夏同耀,孙爱玲,李明,申振伟,卞伟玮,蒋正,康凤玲,柳晓涓,薛付忠,刘静. 健康管理人群慢性肾脏病风险预测模型[J]. 山东大学学报（医学版）, 2017, 55(6): 98-103.

ZHOU Miao, XIA Tongyao, SUN Ailing, LI Ming, SHEN Zhenwei, BIAN Weiwei, JIANG Zheng, KANG Fengling, LIU Xiaojuan, XUE Fuzhong, LIU Jing. Risk prediction model of chronic kidney disease in health management population[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(6): 98-103.

参考文献

[1] Schoolwerth AC, Engelgau MM, Hostetter TH, et al. Chronic kidney disease: a public health problem that needs a public health action plan[J]. Prev Chronic Dis, 2006, 3(2): A57.
[2] 唐盛, 龚智峰, 彭小梅, 等. 广西壮族成年人群慢性肾脏病流行情况及危险因素调查研究[J]. 中国全科医学, 2012,15(27): 3157-3159. TANG Sheng, GONG Zhifeng, PENG Xiaomei, et al. Investigation on prevalence of chronic kidney in Guangxi Zhuang Nationality and its risk factors[J]. Chinese General Practice, 2012, 15(27): 3157-3159.
[3] 李秀梅. 健康体检者慢性肾脏病患病率及危险因素探讨[J]. 中国卫生标准管理, 2015, 6(20): 4-5. LI Xiumei. Prevalence and risk factors of chronic kidney disease in healthy volunteers[J]. China Health Standard Management, 2015, 6(20): 4-5.
[4] 陈茂杰, 汪秀英, 卓朗. 健康体检者慢性肾脏病患病率及危险因素研究[J]. 徐州医学院学报, 2010,30(11): 730-732.
[5] 李军, 李慧. 廊坊市农村成年人群慢性肾脏病患病率及相关危险因素调查分析[J]. 中国血液净化, 2016,15(4): 247-250. LI Jun, LI Hui. A survey of the prevalence of chronic kidney disease and its related risk factors in adults from rural area of Langfang[J]. Chinese Journal of Blood Purification, 2016,15(4): 247-250.
[6] 刘建林, 吕心瑞, 王慧超, 等. 杞县成人体检人群慢性肾脏病患病率及危险因素调查[J]. 中国当代医药, 2015, 22(23): 147-149. LIU Jianlin, LÜ Xinrui, WANG Huichao, et al. Investigation of morbidity rate and risk factor of chronic kidney disease in adult check-up crowd of Qi County[J]. China Modern Medicine, 2015, 22(23): 147-149.
[7] 谢伟基, 张夏兰, 廖翼曼, 等. 汕头地区在职人员的慢性肾脏病发病率调查[J]. 中国中西医结合肾病杂志, 2014, 15(10): 880-886. XIE Weiji, ZHANG Xialan, LIAO Yiman, et al. The epidemiological study of chronic kidney disease in occupational populations in Shantou[J]. Chinese Journal of Integrated Traditional and Western Nephrology, 2014, 15(10): 880-886.
[8] 李道婷, 陈明道, 蔡鸿鹏, 等. 社区体检成人慢性肾脏病患病率及相关因素调查[J]. 浙江预防医学, 2013,25(8): 23-25, 32. LI Daoting, CHEN Mingdao, CAI Hongpeng, et al. A survey on prevalence of chronic kidney disease and its related factors among adults from physical examination in community[J]. Zhejiang Journal of Preventive Medicine, 2013, 25(8): 23-25, 32.
[9] 范文娟, 王淑霞, 米娜娃儿·玉努斯, 等. 新疆地区成年体检人群中慢性肾脏病患病率及相关危险因素调查[J]. 中华肾脏病杂志, 2011,27(6): 400-405. FAN Wenjuan, WANG Shuxia, MINAWAER Yunusi, et al. Prevalence and risk factors of chronic kidney disease in the adult population receiving healthy examination from Xinjiang[J]. Chinese Journal of Nephrology, 2011, 27(6): 400-405.
[10] Yuan J, Zou X, Han S, et al. Prevalence and risk factors for cardiovascular disease among chronic kidney disease patients: results from the Chinese cohort study of chronic kidney disease(C-STRIDE)[J]. BMC Nephrology, 2017, 18(1): 23. doi: 10.1186/s12882-017-0441-9.
[11] Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis[J]. The Lancet, 2010, 375(9731): 2073-2081.
[12] Ahmadi S, Zahmatkesh G, Ahmadi E, et al. Association of body mass index with clinical outcomes in non-dialysis-dependent chronic kidney disease: a systematic review and meta-analysis[J]. Cardiorenal Med, 2015, 6(1): 37-49.
[13] De Nicola L, Provenzano M, Chiodini P, et al. Epidemiology of low-proteinuric chronic kidney disease in renal clinics[J]. PLoS One, 2017, 12(2): e172241. doi: 10.1371/journal.pone.0172241. eCollection 2017.
[14] Ghonemy TA, Farag SE, Soliman SA, et al. Epidemiology and risk factors of chronic kidney disease in the El-Sharkia Governorate, Egypt[J]. Saudi J Kidney Dis Transpl, 2016, 27(1): 111-117.
[15] Chien KL, Lin HJ, Lee BC, et al. A prediction model for the risk of incident chronic kidney disease[J]. Am J Med, 2010, 123(9): 836-846.
[16] Weiner DE, Tighiouart H, Elsayed EF, et al. The Framingham predictive instrument in chronic kidney disease[J]. J Am Coll Cardiol, 2007, 50(3): 217-224.
[17] Bang H, Vupputuri S, Shoham DA, et al. Screening for occult renal disease(SCORED): a simple prediction model for chronic kidney disease[J]. Arch Intern Med, 2007, 167(4): 374-381.
[18] Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate[J]. Ann Intern Med, 2009, 150(9): 604-612.
[19] Kidney Disease: Improving Global Outcomes(KDIGO)CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease[J]. Kidney Int Suppl, 2013, 3(1): 1-150.
[20] 中国高血压防治指南修订委员会. 中国高血压防治指南2010[J]. 中华心血管病杂志, 2011,39(7): 579-616. Writing Group of 2010 Chinese Guidelines for the Management of Hypertension. 2010 Chinese guidelines for the management of hypertension[J]. Chin J Cardiol, 2011, 39(7): 579-616.
[21] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版)[J]. 中华糖尿病杂志, 2014, 6(7): 447-498.
[22] Agarwal R, Light RP. Patterns and prognostic value of total and differential leukocyte count in chronic kidney disease[J]. Clin J Am Soc Nephrol, 2011, 6(6): 1393-1399.
[23] 郭宗琳, 付平, 周雅南, 等. 成都市高血压人群慢性肾脏病流行病学调查研究[J]. 四川医学, 2012, 33(7): 1112-1115. GUO Zonglin, FU Ping, ZHOU Yanan, et al. Epidemiologic study of chronic kidney disease in hypertension of Chengdu[J]. Sichuan Med J, 2012, 33(7): 1112-1115.
[24] 郭宗琳, 廖雪松, 王启容, 等. 成都市高尿酸血症患者慢性肾脏病流行病学调查研究[J]. 临床肾脏病杂志, 2015, 15(11): 659-663. GUO Zonglin, LIAO Xuesong, WANG Qirong, et al. Epidemiologic study of chronic kidney disease in hyperuricemia of Chengdu[J]. Journal of Clinical Nephrology, 2015, 15(11): 659-663.
[25] 迟雁青, 刘琼, 林海英, 等. 血肌酐、血尿素氮评价慢性肾脏病患者肾功能时与年龄的相关性研究[J]. 中国临床实用医学, 2009, 3(5): 36-38. CHI Yanqing, LIU Qiong, LIN Haiying, et al. The study of associativity with renal function and serum creatinine, serum urea nitrogen in different age stages of the chronic kidney disease patients[J]. China Clinical Practical Medicine, 2009, 3(5): 36-38.
[26] Sepanlou SG, Barahimi H, Najafi I, et al. Prevalence and determinants of chronic kidney disease in northeast of Iran: results of the Golestan cohort study[J]. PLoS One, 2017, 12(5): e176540. doi: 10.1371/journal.pone.0176540. eCollection 2017.
[27] Mota E, Popa SG, Mota M, et al. Prevalence of chronic kidney disease and its association with cardio-metabolic risk factors in the adult Romanian population: the PREDATORR study[J]. Int Urol Nephrol, 2015, 47(11): 1831-1838.
[28] Schillaci G, Pirro M, Mannarino MR, et al. Relation between renal function within the normal range and central and peripheral arterial stiffness in hypertension[J]. Hypertension, 2006, 48(4): 616-621.
[29] 马全中, 郭志勇. 高血压肾病的研究现状[J]. 中国医药导报, 2012,9(33): 32-33. MA Quanzhong, GUO Zhiyong. Research of hypertensive nephropathy[J]. China Medical Herald, 2012, 9(33): 32-33.
[30] Ohshiro Y, Ma RC, Yasuda Y, et al. Reduction of diabetes-induced oxidative stress, fibrotic cytokine expression, and renal dysfunction in protein kinase C-null mice[J]. Diabetes, 2006, 55(11): 3112-3120.
[31] Portero-Otín M, Pamplona R, Boada J, et al. Inhibition of renin angiotensin system decreases renal protein oxidative damage in diabetic rats[J]. Biochem Biophys Res Commun, 2008, 368(3): 528-535.
[32] Miyata T, Ueda Y, Horie K, et al. Renal catabolism of advanced glycation end products: the fate of pentosidine[J]. Kidney Int, 1998, 53(2): 416-422.
[33] 吕娇燕, 何睿. 嗜碱性粒细胞对Th2细胞免疫应答调节的研究进展[J]. 国际免疫学杂志, 2012, 35(2): 99-102. LV Jiaoyan, HE Rui. Advances in the study of the role of basophils in regulating Th2 immune response[J]. International Journal of Immunology, 2012, 35(2): 99-102.

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