摘要
目的:糖尿病性ED是糖尿病常见微血管并发症之一。对2型糖尿病患者罹患ED的与血管损害有关的危险因素进行分析,并建立列线图。方法:纳入181例2型糖尿病患者,进行性功能评估,并检索病例系统中患者血管损害相关的临床数据。数据经预处理后均采用各类的例数及百分数进行描述。采用R软件进行统计学分析。通过Lasso回归筛选出的可能的影响因素,在满足根据EPV方法计算Logistic回归分析所需样本量的前提下,将筛选的变量纳入多因素Logistic回归分析,并构建列线图;通过基于Bootstrap法的内部验证法利用C-指数、Calibration曲线、DCA决策曲线对列线图的区分度、校准度和临床有效性进行评价。结果:181例患者中有90例(49.7%)患者诊断为ED。纳入Logistic回归分析的危险因素为:糖尿病病程(OR=4.440, 95%CI=1.594~13.105;OR=7.667,95%CI=1.444~48.733)、颈动脉内膜中层厚度状态(OR=3.767, 95%CI=1.194~12.691)、合并糖尿病视网膜病变(OR=5.382, 95%CI=1.373~28.301)、合并糖尿病肾病(OR=4.959, 95%CI=1.156~27.728)、低密度脂蛋白胆固醇(OR=8.210, 95%CI=2.027~43.507)、红细胞分布宽度(OR=2.418, 95%CI=1.021~5.826)、血浆纤维蛋白原(OR=4.649, 95%CI=2.001~11.339)。C-指数为0.911(95%CI=0.869~0.954)。列线图的表观预测值分布曲线与Calibration图最佳曲线贴合良好。DCA曲线提示阈概率>6%以及<93%时选择该列线图对2型糖尿病罹患糖尿病性ED进行预测可临床获益。结论:本研究结合糖尿病病程、颈动脉内膜中层厚度状态、合并糖尿病视网膜病变、合并糖尿病肾病、低密度脂蛋白胆固醇、红细胞分布宽度、血浆纤维蛋白原这7项独立影响因素,初步建立了预测糖尿病患者罹患ED风险的列线图。
Objective: To analyze vascular damage-related risk factors for ED in patients with type 2 diabetes mellitus(DM) and develop a nomogram for the prediction of the factors. Methods: A total of 181 patients with type 2 DM were included for sexual function assessment, and the clinical data on vascular damage were retrieved from the patients system. After preprocessing, the data were described by the number and percentage of different types of cases and subjected to statistical analysis with the R software. The Lasso regression model was used to optimize feature selection. On the premise of the sample size required for logistic regression analysis according to the number of events per variable, multivariable logistic regression analysis was performed on the selected variables and a nomogram was developed for diabetes-induced erectile dysfunction(DIED). Then, the performance of the nomogram was evaluated with respect to its calibration, discrimination and clinical utility using Harrell’s concordance index(C-index), the calibration plot and decision curve analysis, as well as bootstrapping for internal validation. Results: ED was diagnosed in 90(49.7%) of the 181 patients. The risk factors subjected to logistic regression analysis included the duration of DM(OR = 4.440, 95% CI: 1.594-13.105;OR = 7.667, 95% CI: 1.444-48.733), status of carotid intima-media thickness(c-IMT)(OR = 3.767, 95% CI: 1.194-12.691), diabetic retinopathy(DR)(OR = 5.382, 95% CI: 1.373-28.301), diabetic kidney disease(DKD)(OR = 4.959, 95% CI: 1.156-27.728), low-density lipoprotein cholesterol(LDL-C)(OR = 8.210, 95% CI: 2.027-43.507), red blood cell distribution width(RDW)(OR = 2.418, 95% CI: 1.021-5.826), and plasma fibrinogen(Fbg)(OR = 4.649, 95% CI: 2.001-11.339). The C-index of the DIED model was 0.911(95% CI: 0.869-0.954). The curve representing the performance of the nomogram fit in well with that representing a perfect prediction by the calibration plot. Decision curve analysis indicated that the nomogram was clinically useful for predicting DIED in the type 2 DM patients at the possibility threshold of 6% to 93%. Conclusion: A nomogram was preliminarily developed for predicting the risk of DIED in type 2 DM patients with respect to the seven independent influencing factors, including the duration of DM, status of c-IMT, DR, DKD, LDL-C, RDW, and Fbg.
作者
彭天文
左翼
陈劲果
张海波
张艳红
许桂麒
赵善超
PENG Tian-wen;ZUO Yi;CHEN Jin-guo;ZHANG Hai-bo;ZHANG Yan-hong;XU Gui-qi;ZHAO Shan-chao(Department of Urology,Nanfang Hospital/The First School of Clinical Medicine,Southern Medical University,Guangzhou,Guangdong 510515,China)
出处
《中华男科学杂志》
CAS
CSCD
北大核心
2020年第5期399-408,共10页
National Journal of Andrology
基金
广东省自然科学基金(2018A030313638)。
关键词
勃起功能障碍
2型糖尿病
危险因素
列线图
内部验证
erectile dysfunction
type 2 diabetes mellitus
risk factors
nomogram
internal validation
