目的:构建适用于中国人群的新发2型糖尿病(T2DM)风险评分模型,为T2DM的一级预防提供理论依据和评估工具。方法:研究共纳入了来自淮北市中心血站、东南大学附属中大医院及其下属社区医院共507例受试者,记录受试者的一般临床资料和实验室检验结果。将受试人群按照3∶2的比例随机分配为实验组和验证组。统计组间差异和单因素回归分析来筛选出新发T2DM的危险因素。通过多因素逻辑回归分析的β系数建立风险评分模型。结果:新发T2DM患者胰腺再生蛋白Ⅰα(REG Iα)水平显著高于健康对照组(P＜0.001)。REG Ⅰα是新发T2DM的独立危险因素之一(OR=3.190,P＜0.001)。新发T2DM风险评分模型(New Risk Score Model)纳入的危险因素有REG Ⅰα、性别、BMI、腰围、静息心率、收缩压和高脂血症病史。该模型筛查新发T2DM的AUC在实验组中为0.780(0.723,0.837),验证组中为0.718(0.639,0.797)。当新型风险评分模型的最佳切点值为17.50分时,实验组的敏感性为81.90%,特异度为61.72%,验证组的敏感性为82.09%,特异度为56.25%。新型风险评分模型相较2004年丹麦T2DM风险评分模型和2006年泰国T2DM风险评分模型,具有更高的筛查效能(P<0.05)。结论:基于REG Ⅰα联合危险因素构建的新型风险评分模型具有良好的筛查效能,适用于中国人群新发T2DM的早期识别,对T2DM的一级预防具有重要意义。

[1] OGURTSOVA K,GUARIGUATA L,BARENGO N C,et al.IDF diabetes atlas:global estimates of undiagnosed diabetes in adults for 2021[J].Diabetes Res Clin Pract,2022,183:109118.
[2] GU D,REYNOLDS K,DUAN X,et al.Prevalence of diabetes and impaired fasting glucose in the Chinese adult population:International Collaborative Study of Cardiovascular Disease in Asia(InterASIA)[J].Diabetologia,2003,46(9):1190-1198.
[3] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中国实用内科杂志,2018,38(4):292-344.
[4] BARR E L,ZIMMET P Z,WELBORN T A,et al.Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus,impaired fasting glucose,and impaired glucose tolerance:the Australian Diabetes,Obesity,and Lifestyle Study(AusDiab)[J].Circulation,2007,116(2):151-157.
[5] CHARBONNEL B,SIMON D,DALLONGEVILLE J,et al.Direct medical costs of type 2 diabetes in France:an insurance claims database analysis[J].Pharmacoecon Open,2018,2(2):209-219.
[6] 查彦红.三种2型糖尿病风险评估工具的筛查效果分析[J].浙江实用医学,2015,20(1):14-17.
[7] TERAZONO K,YAMAMOTO H,TAKASAWA S,et al.A novel gene activated in regenerating islets[J].J Biol Chem,1988,263(5):2111-2114.
[8] GRAF R,SCHIESSER M,REDING T,et al.Exocrine meets endocrine:pancreatic stone protein and regenerating protein--two sides of the same coin[J].J Surg Res,2006,133(2):113-120.
[9] YANG J,LI L,RAPTIS D,et al.Pancreatic stone protein/regenerating protein(PSP/reg):a novel secreted protein up-regulated in type 2 diabetes mellitus[J].Endocrine,2015,48(3):856-862.
[10] WATANABE T,YONEKURA H,TERAZONO K,et al.Complete nucleotide sequence of human reg gene and its expression in normal and tumoral tissues.The reg protein,pancreatic stone protein,and pancreatic thread protein are one and the same product of the gene[J].J Biol Chem,1990,265(13):7432-7439.
[11] ASSOCIATION A D.Standards of medical care in diabetes-2020 abridged for primary care providers[J].Clin Diabetes,2020,38(1):10-38.
[12] ZHOU X,QIAO Q,JI L,et al.Nonlaboratory-based risk assessment algorithm for undiagnosed type 2 diabetes developed on a nation-wide diabetes survey[J].Diabetes Care,2013,36(12):3944-3952.
[13] GLUMER C,CARSTENSEN B,SANDBAEK A,et al.A Danish diabetes risk score for targeted screening:the Inter99 study[J].Diabetes Care,2004,27(3):727-733.
[14] YANG J J,YU D,WEN W,et al.Association of diabetes with all-cause and cause-specific mortality in Asia:a pooled analysis of more than 1 million participants[J].JAMA Netw Open,2019,2(4):e192696.
[15] 杨敏,柳洁.中国糖尿病防治现状[J].中国医学创新,2014,11(7):149-151.
[16] SAEEDI P,PETERSOHN I,SALPEA P,et al.Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045:results from the International Diabetes Federation Diabetes Atlas,9(th) edition[J].Diabetes Res Clin Pract,2019,157:107843.
[17] 胡彬.糖尿病前期的临床研究进展[J].中西医结合心血管病电子杂志,2018,6(17):10-14.
[18] XU Y,WANG L,HE J,et al.Prevalence and control of diabetes in Chinese adults[J].JAMA,2013,310(9):948-959.
[19] AEKPLAKORN W,BUNNAG P,WOODWARD M,et al.A risk score for predicting incident diabetes in the Thai population[J].Diabetes Care,2006,29(8):1872-1877.