Establishment And Verification Of Predicting Model Of Diabetic Nephropathy

ObjectiveDiabetic kidney disease (DKD) is a very common disease and the treating methods are quite limited. The microalbunminuria stage is still reversible but once it advances into the clinical urinary albunminuria stage, renal failure becomes unavoidable. Hence, the research on the demographic and clinical characteristics in order to help the prediction for the advancement from the microalbunminuria stage to clinical urinary albunminuria stage weighs a lot in the early diagnosis and intervention, which are the two main elements of the prevention of DKD. This research combines both laboratory test results in modern medicine and Syndrome in TCM to evaluate the risk of advancing into DKD and to build the predictive model, based on the standard research of Syndrome in TCM, so that we can provide a more reliable and convenient predictive method.Methods1 The construction of TCM syndrome elements diagnostic rating scale for DKD:492 DKD patients were included, from which TCM diagnostic physical examination descriptions were taken and filtered with frequency methods, grouping analysis and factor analysis to found the one-to-one relationship between each syndrome and the major syndrome in each syndrome in TCM. With the relationship built, points were given to each syndrome based on the result sorted out by relativity analiysis and logistic regression analysis. The diagnostic threshold were established by ROC curve and confirmed via a diagnostic test of 150 patients.2 The construction and confirmation of the predictive model for the progress of DKD: patients included in the research were dived into two groups by the staging standards:258 patients were in the DKD microalbuminuria stage and the other 234 patients were in the clinical urinary albunminuria stage. The laboratory blood test results were analyzed and compared and the subjects’syndromes were evaluated by the TCM syndrome elements diagnostic rating scale for DKD constructed in section 2, in order to see the difference of the syndrome in TCM between the two groups. The risk factors concluded from these two groups were filtered by multi-factor logistic regression analysis so that the equation with two variable quantities-the blood test results and syndrome in TCM is concluded and its diagnostic function was tested by ROC curve.76 patients in the stage of urinary microalbumine of DKD and the follow-up information after one year were recollected, and the equation is tested by substituting the baseline information.3 The construction and confirmation of the predictive scale for the progress of DKD:By using classification tree, the continuous variables in the logistic regression model were transformed into categorical variables, and then assigned values to them in order to make the prediction model presented in form of scale.492 patients were re-evaluated and the diagnostic efficacy of scale was evaluated by ROC curve. Baseline and one year follow-up information of 76 patients were colletcted, and judgd progression of the disease according to the criteria of diagnosis and staging in order to verify the predictive scale.Results1 The construction of TCM syndrome elements diagnostic rating scale for DKD:there are 61 pieces of TCM diagnostic descriptions, and we keep the useful 32 pieces after filtration.9 syndrome elements are extracted so that the TCM syndrome elements diagnostic rating scale for DKD containing 9 syndrome elements are constructed. These 9 syndrome elements are: syndrome of qi deficiency, syndrome of blood deficiency, syndrome of yin deficiency, syndrome of yang deficiency, heat syndrome, qi-stagnation syndrome, damp heat syndrome, blood stasis syndrome, Phlegm turbidity syndrome.50 points are given to each of the 9 syndrome elements and the threshold number for each of the syndrome to be diagnosed is 14, 9,19,25,25,18,19 and 25. The clinical confirmatory test of a small sample shows the sensitivity of this scale could reach 78.8-100%, the specificity 84.3-100% and the correction 82.7-100%.2 The construction and confirmation of the predictive model for the progress of DKD: ①multiple logistic regression analysis shows:SBP (OR=1.021, P=0.022), albumin (OR=0.888, P=0.000), serum creatinine (OR=1.010, P=0.000), blood urinary acid (OR= 1.004, P=0.000) and the syndrome of yang deficiency (OR=1.793, P=0.006) are relevant to the progress from microalbuminuria stage to the clinical urinary albuminuria stage independently, ②the construction of the predictive equation for DKD progress:P= exp(-0.966+0.021 Bp-0.119Al+0.01Cr+0.004Ua+0.584Yx)/[1+exp(-0.966+0.021Bp-0.119Al+0.01Cr+ 0.004Ua+0.584Yx)]. The area under ROC curve is 0.801 and confirmatory test of a small sample shows a sensitivity of 70%, specificity of 75.8% and a correction of 75%.3 The construction and confirmation of the predictive scale for the progress of DKD: Systolic blood pressure,0 points (<138mmHg) and 10 points (≥138mmHg). Albumin,18 points (<38g/L)、 9 points (38-42g/L) and 0 points (>42g/L). Serum creatinine,0 points (<91umol/L)、 10 points (91-133umol/L) and 20 points (>133umol/L). Blood uric acid,0 points (<350umol/L)、 10 points (350-382umol/L) and 20 points (>382umol/L).Yang deficiency syndrome,0 points (no) and 10 points (yes). The total score was 86 points, and the diagnostic threshold value was 42 points. The area under the ROC curve was 0.852, and the small sample test showed that the sensitivity was 60%, the specificity was 78.8%, and the accuracy was 76.3%.ConclusionsThe predictive model for DKD progress, based on the research of syndrome in TCM, combines well both the laboratory test results in modern medicine and Syndrome in TCM. It could reflect the probability of the progress from microalbuminuria stage to the clinical urinary albuminuria stage, which is very meaningful to the early prediction of DKD and to the early intervention of patients with higher risk.