Influence factors and predictive ability of a risk prediction model for carotid atherosclerosis in a follow-up population
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摘要:
目的 探讨不同性别人群颈动脉硬化发生影响因素，为疾病针对性预防提供参考。 方法 对金昌队列人群按年龄分层随机抽样后进行随访，采用巢式病例对照研究，分析不同性别人群颈动脉硬化发生的影响因素，并建立发病风险预测模型，以受试者工作特征曲线(receiver operator characteristic curve，ROC) 下面积评价模型拟合优度。 结果 该随访人群颈动脉硬化标化发病率为12.32%，男性发病率(13.65%)高于女性(11.29%)，差异有统计学意义(χ2=4.267，P < 0.001)。年龄、文化程度、收缩压升高、低密度脂蛋白升高是男性和女性发病的共同危险因素，空腹血糖升高(OR=2.556，95% CI：1.618~4.038)和甘油三酯升高(OR=1.535，95% CI：1.058~2.227)仅与男性发病有关；腹型肥胖(OR=1.414，95% CI：1.013~1.974)仅与女性发病有关。男性和女性预测模型曲线下面积分别为0.835(95% CI：0.815~0.856)、0.809(95% CI：0.788~0.831)，灵敏度分别为78.0%、78.9%，特异度分别为78.8%、73.1%，诊断一致率分别为91.3%、82.4%。 结论 影响男性和女性颈动脉硬化发生的危险因素不同，应分性别采取针对性防控措施，运用Logistic回归建立的发病风险预测模型有一定的指导价值。 Abstract:Objective To explore factors influencing the incidence of carotid atherosclerosis in different genders so as to provide reference for the specific prevention of the disease. Methods A nested case-control study was conducted to analyze factors influencing the incidence of carotid atherosclerosis in Jinchang cohort population who were randomly selected through stratified sampling by age and followed up. A risk prediction model was established and the goodness of fit was evaluated by the area under the receiver operator characteristic curve (ROC). Results The standardized incidence of carotid atherosclerosis in this follow-up population was 12.32%, and the incidence rate of males (13.65%) was greater than that of females (11.29%). The difference was statistically significant (χ2=4.267, P < 0.001). Age, education, elevated systolic blood pressure, and elevated low-density lipoprotein cholesterol were common risk factors for carotid atherosclerosis in both men and women. Elevated fasting plasma glucose (OR=2.556, 95% CI: 1.618-4.038) and elevated triglyceride (OR=1.535, 95% CI: 1.058-2.227) were only associated with men. Abdominal obesity (OR=1.414, 95% CI: 1.013-1.974) was only associated with women. The area under ROC of male and female prediction models was 0.835 (95% CI: 0.815-0.856) and 0.809 (95% CI: 0.788-0.831), respectively. The sensitivity was 78.0% and 78.9%, the specificity was 78.8% and 73.1%, and the diagnostic coincidence rate was 91.3% and 82.4%, respectively. Conclusions There are different risk factors for carotid atherosclerosis in males and females, and targeted prevention and control measures should be taken according to gender. The risk prediction model established by Logistic regression had certain guiding value. -
表 1 随访人群颈动脉硬化发生情况
Table 1. The incidence of carotid atherosclerosis in the follow-up population
分组 男性 女性 总人群 例数 发病数 发病率(%) 例数 发病数 发病率(%) 例数 发病数 发病率(%) 年龄组(岁) < 40 803 22 2.74 329 4 1.22 1 132 26 2.30 40~ 687 49 7.13 528 26 4.92 1 215 75 6.17 50~ 199 53 26.63 256 64 25.00 455 117 25.71 60~ 67 37 55.22 311 142 45.66 378 179 47.35 ≥70 18 12 66.67 35 18 51.43 53 30 56.60 文化程度 初中及以下 310 69 22.26 661 205 31.01 971 274 28.22 高中/中专/大专 1 029 83 8.07 495 47 9.49 1 524 130 8.53 本科及以上 435 21 4.83 303 2 0.66 738 23 3.12 职业 技术人员 131 8 6.11 65 0 0.00 196 8 4.08 干部 295 23 7.80 266 6 2.26 561 29 5.17 工人 1 287 117 9.09 859 143 16.65 2 146 260 12.12 内勤服务人员 35 11 31.43 249 95 38.15 284 106 37.32 
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表 2 多因素Logistic回归变量赋值表
Table 2. Variable assignment of multi-factor Logistic regression
变量 赋值说明 年龄 > 50岁 0=否，1=是 文化程度 0=初中及以下，1=高中/中专/大专，2=本科及以上 BMI≥24 kg/m 2 0=否，1=是 吸烟 0=否，1=是 高油膳食 0=油脂较低，1=适中，2=油脂较高 高糖膳食 0=低糖，1=适中，2=高糖 高盐膳食 0=清淡，1=适中，2=高盐 腰围≥90(85) cm 0=否，1=是 FPG > 6.1 mmol/L 0=否，1=是 SBP≥140 mmHg 0=否，1=是 DBP≥90 mmHg 0=否，1=是 TG > 1.7 mmol/L 0=否，1=是 TC > 5.2 mmol/L 0=否，1=是 LDL-C > 3.4 mmol/L 0=否，1=是 HDL-C < 1.04 mmol/L 0=否，1=是 随访是否发病 0=否，1=是
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表 3 随访人群颈动脉硬化发生影响因素的多因素Logistic回归
Table 3. Multivariate Logistic regression analysis on risk factors of carotid atherosclerosis in the follow-up population
影响因素 β sx Wald值 P值 OR(95% CI)值 男性 FPG升高 0.938 0.233 16.169 < 0.001 2.556(1.618~4.038) TG升高 0.428 0.190 5.092 0.024 1.535(1.058~2.227) SBP升高 0.664 0.231 8.286 0.004 1.942(1.236~3.051) LDL-C升高 0.500 0.193 6.670 0.010 1.648(1.128~2.408) 年龄 2.077 0.192 117.559 < 0.001 7.979(5.482~11.614) 文化程度 初中及以下 1.00 高中/中专/大专 -0.584 0.206 8.003 0.005 0.558(0.372~0.836) 本科及以上 -0.935 0.291 10.341 0.001 0.393(0.222~0.694) 常数项 -6.539 0.445 169.261 < 0.001 女性 SBP升高 0.592 0.171 11.979 0.001 1.807(1.293~2.526) LDL-C升高 0.355 0.160 4.945 0.026 1.427(1.043~1.951) 腹型肥胖 0.346 0.170 4.144 0.042 1.414(1.013~1.974) 年龄 2.286 0.382 35.885 < 0.001 9.835(4.655~20.777) 文化程度 初中及以下 1.00 高中/中专/大专 -0.699 0.190 13.478 < 0.001 0.497(0.342~0.722) 本科及以上 -2.844 0.728 15.261 < 0.001 0.058(0.014~0.2442) 常数项 -6.020 0.781 59.353 < 0.001
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