1型糖尿病患儿血管并发症的风险预测模型建立与验证

Establishment and validation of a risk prediction model for vascular complications in children with type 1 diabetes mellitus

摘要

目的 建立1型糖尿病(T1DM)患儿血管并发症的风险预测模型,并验证其预测效能。方法 回顾性分析2021年1月至2024年6月天津市儿童医院收治的385例T1DM患儿的临床资料,按7∶3的比例将其随机分为建模组(270例)和验证组(115例)。另根据建模组是否发生血管并发症将其分为并发组和未并发组,采用单因素Logistic回归分析建模组T1DM患儿血管并发症的影响因素。采用多因素Logistic回归建立风险预测模型;利用受试者工作特征(ROC)曲线、校准曲线及决策曲线分析(DCA)评价预测效能,并绘制列线图。结果 T1DM患儿血管并发症发生率为25.19%(97/385);并发组糖化血红蛋白(HbA1c)、稳态模型胰岛素抵抗指数(HOMA-IR)、低密度脂蛋白(LDL)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、尿白蛋白/尿肌酐比值(UACR)水平均高于未并发组,差异有统计学意义(t值介于3.542~8.447之间,P<0.05);多因素Logistic回归模型分析结果显示高水平HbA1c、HOMA-IR、LDL、PLR、UACR均是T1DM患儿血管并发症的危险因素(OR值介于1.301~2.697之间,P<0.05);ROC曲线分析显示,建模组、验证组模型预测T1DM患儿血管并发症的曲线下面积分别为0.881、0.872,一致性指数分别为0.841、0.845,校准曲线与理想曲线基本一致;DCA曲线显示,建模组、验证组模型阈值概率分别为0.11~0.90、0.10~0.83时具有较高的临床净收益。结论 高水平HbA1c、HOMA-IR、LDL、PLR、UACR均是1型糖尿病患儿血管并发症的危险因素,基于此建立的风险预测模型及列线图具有较高的预测效能,在门诊筛查或高危患儿风险管理方面具有较高的临床应用价值。

Abstract

Objective To establish a risk prediction model for vascular complications in children with type 1 diabetes mellitus (T1DM) and to validate its predictive performance. Methods A retrospective analysis was conducted on the clinical data of 385 children with T1DM admitted to Tianjin Children's Hospital from January 2021 to June 2024. The patients were randomly divided into a training group (270 cases) and a validation group (115 cases) at a ratio of 7:3. According to the occurrence of vascular complications in the training group, the patients were further divided into a complication group and a non-complication group. Univariate Logistic regression analysis was performed to identify factors influencing vascular complications in children with T1DM in the training group. A multivariate Logistic regression model was then constructed to establish the risk prediction model. Receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were used to evaluate the predictive performance of the model, and a nomogram was generated. Results The incidence of vascular complications in children with T1DM was 25.19% (97/385). Levels of glycated hemoglobin (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), low-density lipoprotein (LDL), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and urinary albumin-to-creatinine ratio (UACR) in the complication group were significantly higher than those in the non-complication group (t values ranging from 3.542 to 8.447, P<0.05). Multivariate Logistic regression analysis showed that elevated HbA1c, HOMA-IR, LDL, PLR, and UACR were independent risk factors for vascular complications in children with T1DM (OR values ranging from 1.301 to 2.697, P<0.05). ROC curve analysis demonstrated that the areas under the curve (AUC) of the model for predicting vascular complications in children with T1DM were 0.881 and 0.872 in the training and validation groups, respectively. The concordance indices were 0.841 and 0.845, respectively. The calibration curves were generally consistent with the ideal curves. DCA showed that the model achieved favorable clinical net benefits when the threshold probabilities ranged from 0.11 to 0.90 in the training group and from 0.10 to 0.83 in the validation group. Conclusion Elevated HbA1c, HOMA-IR, LDL, PLR, and UACR are risk factors for vascular complications in children with T1DM. The risk prediction model and nomogram established based on these factors demonstrated good predictive performance and may have substantial clinical value in outpatient screening and risk management of high-risk pediatric patients.

关键词

儿童 / 1型糖尿病 / 血管并发症 / 影响因素 / 列线图

Key words

child / type 1 diabetes / vascular complication / influencing factor / nomogram

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基金资助

天津市卫生健康科技项目(TJWJ2022QN084)