摘要
目的对已建立的国人缺血性心脑血管病(ischemic cardiovascular disease,ICVD)10年发病危险的评估方法及简易评估工具进行验证。方法用中国心血管病流行病学多中心协作研究于"八五"攻关期间建立的另一队列研究人群来进行验证。用 ROC 曲线下面积检验预测模型对该队列中事件与非事件的判别能力。用 Hosmer-Lemeshow 检验比较每十分位分组的预测发病率和实际发病人年率来判断预测的准确性。结果本研究队列入组年龄35～59岁,平均随访11年。剔除预测模型所用危险因素资料不全者后余15 100人进入本研究分析,共累积 ICVD 事件数347例(男性206例、女性141例);其中冠心病83例(男性56例、女性27例),缺血性卒中268例(男性154例、女性114例)。在男女性最优模型、简易模型、评分法预测"八五"队列人群得到的 ROC 曲线均显示了很好且基本接近的判别能力。ROC 曲线下面积分别为:最优模型(男性0.796,女性0.791);简易模型(男性0.792,女性0.783);评分法(男性0.791,女性0.779)。将预测的10年 ICVD 发病概率和实际的10年发病人年率进行 Hosmer-Lemeshow x^2检验,男性 x^2=3.7(P=0.879),女性 x^2=27.7(P<0.01),但预测率和实际率之间的最大差值仅有1%,显示了较好的预测准确度。结论经本研究队列人群的验证,证明已建立的缺血性心脑血管病10年发病危险评估方法和简易评估工具对我国现阶段中年人群有较好的预测能力,具有推广价值。
Objective To evaluate the applicability of developed prediction models of ischemic cardiovascular diseases （ICVD） in Chinese to other Chinese populations. Method We used the independent prospective cohort established in early 1990＇s from China Multi-Center Collaborative Study of Cardiovascular Epidemiology （MUCA）, as the validation cohort, to test the hypothesis. The area under ROC curve （AUC） based on the application of the Cox optimal model and the simplified model to the validation cohort were calculated and to test the ability of the prediction models to discriminate events from nonevents. Applicability was evaluated by comparing the mean probability estimates in each decile of probability in the validation cohort with the observed incidence with the Hosmer-Lemeshow test. Results The validation cohort enrolled a total of 17 329 men and women aged 35 to 59 years baseline 1992-1994. In this paper, we used data from the remaining 15 100 participants after excluding 2229 subjects for at missing value of risk factors. During 11-year follow up of the cohort, there were 347 ICVD events （206 for men and 141 for women）, including 83 coronary heart disease events （56 men and 27 women） and 268 ischemic strokes （154 men and 114 women）. ROC curves for men and women showed good and almost identical discrimination for optimal model （the AUCs （95% CI） were 0.796 （0.762-0.829） for men and 0.791 （0. 755-0. 828） for women）, simplified model （the AUCs （95% CI） were 0. 792 （0. 758-0. 825） for men and 0. 783 （0. 746-0. 821 ） for women） and score system （the AUCs （95% CI） were 0. 791 （0. 757-0. 825） for men and 0. 779 （0. 741-0. 817） for women） in the validation cohort. The predicted 10-year risk of ICVD by optimal models and observed incidence of ICVD in the validation cohort in each decile were compared. Hosmer-Lemeshow X^2 was 3.7 for men （P =0. 879） and 27.7 for women （P 〈0. 001 ）. Whereas the largest difference between the observed rate and the
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2007年第8期761-764,共4页
Chinese Journal of Cardiology
基金
国家"十五"科技攻关课题项目资助(2004BA703801)
关键词
心血管疾病
危险性评估
预测
Cardiovascular diseases
Risk assessment
Forecasting （ ischemic cardiovascular disease, ICVD
