摘要
目的探讨血液检测指标及其变化情况与空腹血糖受损的关系,进行风险预测研究。方法以2018年1月至2019年12月在山东第一医科大学第一附属医院健康管理中心进行健康体检、2次体检时间间隔6个月及以上、第1年进行健康体检时无糖尿病史且空腹血糖正常者为研究对象,以第2年空腹血糖水平为因变量,分别以第1年一般检查和血液检查指标、第2年一般检查和血液检查指标的变化量为自变量构建模型。首先使用随机森林模型筛选自变量,然后拟合Logistic回归模型计算自变量的效应值。结果共纳入研究对象4416人,经1年随访,基线血糖正常者中3.45%(133/3851)发展为糖尿病前期血糖,0.42%(16/3851)发展为糖尿病血糖。利用血液检测指标预测1年后空腹血糖变化情况的灵敏度为67.1%,特异度为100.0%,年龄偏大(OR值为1.024,95%CI 1.014~1.035)、收缩压偏高(OR值为1.018,95%CI 1.011~1.025)、体质量指数偏高(OR值为1.079,95%CI 1.036~1.125)、尿酸偏高(OR值为1.003,95%CI 1.002~1.005)、谷氨酰转肽酶偏高(OR值为1.006,95%CI 1.003~1.010)、肌酐偏低(OR值为0.971,95%CI 0.957~0.985)、AST/ALT偏低(OR值为0.614,95%CI 0.411~0.917)、估算的肾小球滤过率偏低(OR值为0.972,95%CI 0.958~0.988)者1年后出现空腹血糖受损的可能性大。利用血液检测指标的变化情况预测1年后空腹血糖变化情况的灵敏度为65.2%,特异度为99.7%,1年内三酰甘油升高(OR值为1.152,95%CI 1.057~1.257)、碱性磷酸酶升高(OR值为1.021,95%CI 1.012~1.030)、白蛋白升高(OR值为1.087,95%CI 1.029~1.148)、AST升高(OR值为1.006,95%CI 1.003~1.009)、体质量增加(OR值为1.049,95%CI 1.019~1.081)者出现空腹血糖受损的可能性大。结论年龄偏大、收缩压偏高、体质量指数偏高、尿酸偏高、谷氨酰转肽酶偏高、肌酐偏低、AST/ALT偏低、估算的肾小球滤过率偏低者1年后出现空腹血糖受损的可能性大,1年内三酰甘油升高、碱性磷酸酶升高、白蛋白升高、AST升高、体质量增加者出现空腹血糖受损的可能性大。当体检者出现以上情况时,应注意监测血糖,及时进行干预,以阻止或延缓糖尿病的发生发展。
Objective To explore the relationship between blood test indicators and their changes and impaired fasting blood glucose,and to conduct risk prediction research.Methods This study selected people who underwent a physical examination at a health management center in Jinan from 2018 to 2019,with an interval of 6 months or more between the two physical examinations,and had no history of diabetes and normal fasting blood sugar during the first year of the physical examination.We took the fasting blood glucose level in the second year as the dependent variable,and took the general examination and blood test indicators in the first year as well as the changes of these indicators as independent variables to construct the model.First,the random forest model was used to screen the independent variables,and then the logistic regression model is fitted to calculate the effect values of the independent variables.Results A total of 4416 subjects were enrolled in this study.After a 1-year follow-up,3.45%(133/3851)subjects developed prediabetic blood glucose,and 0.42%(16/3851)developed diabetic blood glucose.The sensitivity of the model using blood test indicators to predict the risk of impaired fasting blood glucose after 1 year was 67.1%,and the specificity was 100.0%.The risk of impaired fasting blood glucose after 1 year was high in the population with older age(OR value was 1.024,95%CI 1.014-1.035),higher systolic blood pressure(OR value was 1.018,95%CI 1.011-1.025),higher body mass index(OR value was 1.079,95%CI 1.036-1.125),higher uric acid(OR value was 1.003,95%CI 1.002-1.005),higher glutamyl transpeptidase(OR value was 1.006,95%CI 1.003-1.010),lower creatinine(OR value was 0.971,95%CI 0.957-0.985),lower AST/ALT(OR value was 0.614,95%CI 0.411-0.917)and lower estimated glomerular filtration rate(OR value was 0.972,95%CI 0.958-0.988).The sensitivity of the model using the changes of blood test indicators to predict the risk of impaired fasting blood glucose after 1 year was 65.2%,and the specificity was 99.7%.The risk of impaired fasting blood glucose is high in the population with increased triglycerides(OR value was 1.152,95%CI 1.057-1.257),increased alkaline phosphatase(OR value was 1.021,95%CI 1.012-1.030),increased albumin(OR value was 1.087,95%CI 1.029-1.148),increased aspartate aminotransferase(OR value was 1.006,95%CI 1.003-1.009),increased weight(OR value was 1.049,95%CI 1.019-1.081)within 1 year.Conclusions The possibility of impaired fasting blood glucose after 1 year is high in the population with older age,higher systolic blood pressure,higher body mass index,higher uric acid,higher glutamyl transpeptidase,lower creatinine,lower AST/ALT and lower estimated glomerular filtration rate.The possibility of impaired fasting blood glucose is high in the population with increased triglycerides,increased alkaline phosphatase,increased albumin,increased aspartate aminotransferase and increased weight with in 1 year.When the above situation occurs in the physical examination,the blood glucose should be monitored and timely intervention should be taken to prevent the development of diabetes.
作者
张红玉
胡文琦
许翠萍
Zhang Hongyu;Hu Wenqi;Xu Cuiqing(Department of Health Management,Shandong Provincial Qianfoshan Hospital,Shandong University,Jinan 250014,China;Department of Health Management,the First Affiliated Hospital of Shandong First Medical University,Jinan 250014,China;Department of Nursing,Shandong Provincial Qianfoshan Hospital,Shandong University,Jinan 250014,China)
出处
《中国实用护理杂志》
2021年第23期1767-1774,共8页
Chinese Journal of Practical Nursing
基金
山东省重点研发计划(公益科技攻关类)(2019GGX101044)
山东省重点研发计划(软科学项目)(2020RKB14134)
山东省医药卫生科技发展计划(202014051208)。
关键词
空腹血糖
血液检测
风险预测
随机森林
Fasting blood glucose
Blood test
Risk prediction
Random forest
