Establishment and verification of clinical prediction model of hypertension complicated with diabetes in elderly people in community
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摘要:
目的 分析社区老年高血压患者发生糖尿病的危险因素，并构建预测模型，以期为社区老年高血压患者合并糖尿病的防控提供参考依据。 方法 收集2023年4月—2024年3月在团结新村社区卫生服务中心参与慢性病管理的1 859例≥65岁老年高血压患者的临床资料。将数据采用简单随机抽样的方法按7∶3的比例拆分为训练集(1 301例)和验证集(558例)，通过LASSO回归对变量降维，进行多因素logistic回归分析研究高血压合并糖尿病的危险因素，构建Nomogram预测模型，并使用验证集进行内部验证。使用受试者工作特征曲线评估模型区分度，绘制校正曲线并进行H-L检验评估模型一致性，通过决策分析评估模型有效性。 结果 在1 859例社区老年高血压患者中，有546人(29.37%)患有糖尿病。多因素logistic回归显示，慢性病家族史、乏力、胸闷和嗜糖均为高血压合并糖尿病的独立危险因素；而认知功能较好和日常锻炼则为保护性因素。训练集构建预测模型的AUC为0.873(95% CI：0.850~0.873)，校正曲线斜率接近1，且H-L拟合优度检验χ2=6.511，P=0.260，一致性较好。决策曲线提示模型能够产生净获益。 结论 该社区老年人高血压合并糖尿病的患病率较高，基于社区可测量的6个临床特征构建的预测模型在预测高血压合并糖尿病的发生时表现出良好的预测能力和临床应用价值。 Abstract:Objective The objective of this study is two-fold: firstly, to analyze the risk factors associated with diabetes in elderly patients suffering from hypertension in the community, and secondly, to construct a prediction model. The ultimate aim of this study is to provide a reference for the prevention and management of diabetes in elderly patients suffering from hypertension in the community. Methods From April 2023 to March 2024, the clinical data of 1 859 elderly patients with hypertension aged 65 years and over who participated in chronic disease management in the Tuanjie Community Health Service Centre were collected for the purpose of the study. The data were randomly partitioned into a training set comprising 1 301 cases and a validation set consisting of 558 cases, at a ratio of 7∶3 by means of a simple random sampling method. The LASSO regression method was employed to reduce the dimensionality of the variables, while multivariate logistic regression analysis was conducted to investigate the risk factors associated with hypertension in conjunction with diabetes. Subsequently, a Nomogram prediction model was developed. The validation set was utilized for the purpose of internal validation. The receiver operating characteristic curve (AUC) was employed to evaluate the discrimination of the model, the calibration curve was delineated and the Hosmer-Lemeshow test was used to evaluate the consistency of the model, and the decision analysis was used to evaluate the validity of the model. Results In a study of 1 859 elderly hypertensive patients, 546 (29.37%) were found to have diabetes mellitus. Multivariate logistic regression analysis demonstrated that a family history of chronic diseases, fatigue, chest tightness and sugar addiction were independent risk factors for hypertension combined with diabetes. Nevertheless, superior cognitive function and the undertaking of daily exercise were found to be protective factors. The area under the curve (AUC) of the prediction model constructed from the training set was 0.873 (95% CI: 0.850-0.873). The calibration curve' s slope was close to 1, and the H-L goodness of fit test yielded a chi-squared value of 6.511, a P value of 0.260, and good consistency. The decision curve indicated a net benefit from the model. Conclusion The prevalence of hypertension in combination with diabetes is high among the elderly population in this community. The prediction model, which is based on six community-measurable clinical characteristics, demonstrates both good predictive ability and clinical application value in predicting the occurrence of hypertension in combination with diabetes. -
Key words:
- Hypertension /
- Diabetes /
- Community /
- Elderly /
- Predictive model
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图 1 LASSO回归模型筛选预测变量
注：A为预测变量系数曲线图，B为10倍交叉验证变量筛选图。
Figure 1. LASSO regression model screening predictor variables
图 2 高血压合并糖尿病发生风险的列线图预测模型
Figure 2. Nomogram prediction model for the risk of hypertension combined with diabetes
图 3 预测模型的ROC曲线及校准曲线
注：A为ROC曲线，B为校正曲线。
Figure 3. ROC curve and calibration curve of the prediction model
图 4 高血压合并糖尿病预测模型的决策曲线
Figure 4. Decision curve of prediction model for hypertension combined with diabetes
表 1 高血压患者合并糖尿病影响因素的单因素分析[例(%)]
Table 1. Univariate analysis of influencing factors of hypertension combined with diabetes [cases (%)]
变量 高血压合并糖尿病组(n=382) 单纯高血压组
(n=919)合计
(n=1 301)统计量 P值 性别 2.364a 0.124 男性 171(44.8) 369(40.2) 540(41.5) 女性 211(55.2) 550(59.8) 761(58.5) 年龄 －0.031b 0.975 65~74岁 213(55.8) 516(56.1) 729(56.0) 75~84岁 125(32.7) 292(31.8) 417(32.1) ≥85岁 44(28.4) 111(12.1) 155(11.9) 民族 6.437a 0.011 汉族 371(97.1) 910(99.0) 1 281(98.5) 少数民族 11(2.9) 9(1.0) 20(1.5) 文化程度 -0.494b 0.621 小学及以下 80(20.9) 176(19.2) 256(19.7) 初中或高中 235(61.5) 616(67.0) 851(65.4) 专科及以上 67(17.5) 127(13.8) 194(14.9) 医疗保险 367(96.1) 874(95.1) 1 241(95.4) 0.577a 0.447 药物过敏史 34(8.9) 54(5.9) 88(6.8) 3.914a 0.048 慢性病家族史 102(26.7) 161(17.5) 263(20.2) 25.066a ＜0.001 头晕 39(10.2) 51(5.5) 90(6.9) 9.100a 0.003 乏力 44(11.5) 14(1.5) 58(4.5) 63.287a ＜0.001 胸闷 28(7.3) 21(2.3) 49(3.8) 18.947a ＜0.001 腹型肥胖 168(44.0) 407(44.3) 575(44.2) 0.010a 0.919 肥胖 42(11.0) 108(11.8) 150(11.5) 0.152a 0.697 健康满意度 18.374a ＜0.001 满意 308(80.6) 822(89.4) 1 130(86.9) 不满意 74(19.4) 97(10.6) 171(13.1) 自理能力 1.521a 0.217 可自理 353(92.4) 866(94.2) 1 219(93.7) 不自理 29(7.6) 53(5.8) 82(6.3) 认知功能 439.513a ＜0.001 阴性 113(29.6) 806(87.7) 919(70.6) 阳性 269(70.4) 113(12.3) 382(29.4) 情感状态 42.528a ＜0.001 阴性 317(83.0) 867(94.3) 1 184(91.0) 阳性 65(17.0) 52(5.7) 117(9.0) 锻炼 304(79.6) 805(87.6) 1 109(85.2) 13.776a ＜0.001 嗜糖 96(25.1) 13(1.4) 109(8.4) 197.719a ＜0.001 饮酒 79(20.7) 110(12.0) 189(14.5) 16.491a ＜0.001 吸烟 100(26.2) 150(16.3) 250(19.2) 16.885a ＜0.001 注：a为χ2值，b为Z值。 
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表 2 变量赋值情况
Table 2. Variable assignment
变量 赋值方法 变量 赋值方法 高血压合并糖尿病 是=1，否=0 民族 汉族=1，少数民族=0 药物过敏史 有=1，无=0 头晕 有=1，无=0 慢性病家族史 有=1，无=0 乏力 有=1，无=0 健康满意度 满意=1，不满意=0 胸闷 有=1，无=0 认知功能 阳性=1，阴性=0 锻炼 是=1，否=0 情感状态 阳性=1，阴性=0 嗜糖 是=1，否=0 饮酒 是=1，否=0 吸烟 是=1，否=0
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表 3 高血压合并糖尿病影响因素的logistic回归分析
Table 3. Logistic regression analysis of influencing factors of hypertension combined with diabetes
变量 B SE Waldχ2 P值 OR值(95% CI) 慢性病家族史 0.690 0.199 12.048 < 0.001 1.994(1.350~2.350) 乏力 2.157 0.397 29.587 < 0.001 8.647(3.974~18.811) 胸闷 1.085 0.405 7.184 0.007 2.960(1.339~6.545) 认知功能 -2.856 0.171 278.646 < 0.001 0.057(0.041~0.080) 锻炼 -0.725 0.220 10.839 < 0.001 0.485(0.315~0.745) 嗜糖 3.120 0.348 80.278 < 0.001 22.649(11.445~44.818)
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