| Background: Type 1 diabetic nephropathy(T1DN)is a common and serious microvascular complication of type 1 diabetes mellitus(T1DM)and is the leading cause of end-stage kidney disease(ESKD)in recent years.There are many complex factors in diabetic nephropathy(DN),and few studies have been reported.Objective: To estimate the cumulative incidence of T1 DN in patients with T1 DN over 5 years.To analyze the risk factors for T1 DN and the dose-response relationship with T1DN;to develop a T1 DN prediction model,and to provide clinical guidance for the prevention and treatment of T1 DN.Methods: A retrospective study was conducted to collect electronic medical records of T1 DM patients from January 2016 to December 2021 in several tertiary care hospitals in Lanzhou,Gansu Province,and the 5-year cumulative incidence of T1 DN was estimated using the life table method;the cox proportional risk model was used to analyze the risk factors affecting T1DN;the restrictive cubic spline function was used to fit the relevant risk factors to the risk of T1DN;the ROC(Receiver Operating Characteristic,ROC)curve was used to evaluate the predictive efficacy of the cox proportional risk model and Framingham risk assessment model for T1 DN.The ROC(Receiver Operating Characteristic,ROC)curve was used to evaluate the predictive efficiency of the cox proportional risk model and Framingham risk assessment model for T1 DN.Results:1.Within 5 years of T1 DM diagnosis,T1 DN occurred in 108 patients(24.88%);compared with type 1 diabetes non-nephropathy patients,it showed a difference in the two groups,in terms of age,age of onset,body mass index(BMI),fasting C-peptide,high-density lipoprotein cholesterol(HDLC),total bilirubin(TBIL),direct bilirubin(DBIL),and the presence of ketosis or ketosis;2.The 5-year cumulative incidence of T1 DN was estimated by the life table method to be 29.89% in patients with T1 DN,and the cumulative incidence showed an increasing trend year by year.The 5-year cumulative incidence was 47.59% for patients aged <18 years and 24.24% for patients aged ≥18 years;the 5-year cumulative incidence was 42.75% for patients with ketosis or ketoacidosis and 22.90% for patients without ketosis or ketoacidosis3.multifactorial cox proportional risk regression analysis showed that the risk of DN in patients with T1 DM aged ≥18 years was 0.534 times(95% CI: 0.306-0.710)less than that in patients <18 years;the risk increased with decreasing age in patients under18 years of age and decreased with increasing age in patients ≥18 years of age,with a non-linear relationship;the risk of DN in patients with ketosis The risk of T1 DN in patients with ketosis or ketoacidosis was 1.623 times(95% CI: 1.099-2.454)higher than in patients without ketosis or ketoacidosis;the risk of T1 DN decreased 0.528 times(95%CI: 0.261-0.851)for each unit increase in HDLC,with a non-linear relationship;when the SCr value was greater than 57.9μmol /L,the risk of DN increased 1.003 times(95%CI: 1.001-1.006)for each unit increase in SCr,with a non-linear relationship;4.The accuracy of the cox proportional risk regression model and Framingham model for predicting the occurrence of T1 DN was 0.6716 and 0.5855,respectively.Conclusions:1.the 5-year cumulative incidence of DN in patients with T1 DM tends to increase year by year;2.the younger the age of T1 DM patients,the higher the risk of developing T1DN;3.the HDLC of T1 DM patients is a protective factor for the development of DN,and the lower the HDLC,the higher the risk of developing T1DN;4.the SCr level of T1 DM patients is a risk factor for the occurrence of T1 DN,the higher the SCr level,the higher the risk of T1 DN occurrence;5.the value of the cox proportional risk regression model to predict the occurrence of T1 DN was greater than that predicted the by Framingham model. |
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