Validation of a differential diagnostic model of diabetic nephropathy and non-diabetic renal diseases and the establishment of a new diagnostic model
Validation of a differential diagnostic model of diabetic nephropathy and non-diabetic renal diseases and the establishment of a new diagnostic model
复制标题
糖尿病肾病与非糖尿病肾病鉴别诊断模型的验证及新诊断模型的建立
DOI：
10.1111/1753-0407.12150
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发表时间：
2014-11-01
影响因子：
4.5
通讯作者：
Bai, Xue-yuan
中科院分区：
文献类型：
--
作者：
Liu, Mo-yan;Chen, Xiang-mei;Bai, Xue-yuan
背景：本研究的目的是验证2003年建立的糖尿病肾病与非糖尿病肾病的鉴别诊断模型，并建立适合当前糖尿病肾病临床特点的新的诊断模型。方法：对2004年至2012年接受肾活检的200例2型糖尿病患者进行研究。以1993~2003年收集的数据为基础，对2003年的鉴别诊断模型进行了评价，分析了糖尿病肾病和糖尿病视网膜病变临床鉴别参数的变化。应用Logistic回归、受试者操作特征(ROC)曲线、净重分类改进(NRI)和综合判别改进(IDI)分析。结果：2003年诊断模型的准确率为77.5%。与1993-2003年间相比，2004-2012年糖尿病肾病组的血尿发生率显著增加，糖尿病病史延长，糖化血红蛋白(HbA1c)水平降低。糖尿病(DM)、收缩压(BP)、糖化血红蛋白(Gh)、血尿(HU)、糖尿病视网膜病变(DR)和血红蛋白(Hb)病史与糖尿病肾病独立相关。由此建立了新的诊断模型：P-dN=EXP(0.846+0.022 DM+0.033Bp+2.050 Gh-2.664 Hu-0.078 Hb+2.942 DR)/[1+EXP(0.846+0.022 Dm+0.033 BP+2.050 Gh-2.664Hu-0.078 Hb+2.942 DR)]。经验证性检验，新模型的准确率为90.9%。结论：糖尿病肾病患者临床特征的变化降低了2003年诊断模型的诊断效能。新建立的模型可以更好地、更新地区分糖尿病肾病和非糖尿病肾病。
Background: The aims of the present study were to validate the differential diagnostic model of diabetic nephropathy (DN) and non-diabetic renal diseases (NDRD) established in 2003 and to establish a new diagnostic model suitable for the current clinical characteristics of DN.Methods: We examined 200 patients with Type 2 diabetes who underwent kidney biopsy from 2004 to 2012. The 2003 differential diagnostic model based on the data collected from 1993 to 2003 was evaluated by the diagnostic test and changes in the clinical differentiation parameters of DN and NDRD were analyzed. Logistic regression, receiver operating characteristics (ROC) curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) analysis were applied.Results: The 2003 diagnostic model showed an accuracy of 77.5%. A significantly elevated incidence of hematuria, longer history of diabetes, and reduced level of glycated hemoglobin (HbA1c) were observed in the DN group from 2004 to 2012 compared with DN group from 1993 to 2003. Histories of diabetes mellitus (Dm), systolic blood pressure (Bp), HbA1c (Gh), hematuria (Hu), diabetic retinopathy (Dr), and hemoglobin (Hb) are independently related to DN. Thus, a new diagnostic model was constructed as follows: P-DN = exp (0.846 + 0.022 Dm + 0.033Bp + 2.050 Gh-2.664 Hu-0.078 Hb + 2.942Dr)/[1 + exp (0.846 + 0.022 Dm + 0.033 Bp + 2.050 Gh-2.664 Hu-0.078 Hb + 2.942 Dr)]. Validation tests determined that the accuracy of the new model were 90.9%.Conclusions: Changes in people with DN, clinical characteristics have reduced the diagnostic efficacy of the 2003 diagnostic model. The newly established model can provide a better, more current differentiation between DN and NDRD.