慢性肾脏病3-4期糖尿病肾脏疾病患者进展到终末期肾病的危险因素分类树模型分析

【目的】分析糖尿病肾脏疾病（DKD）患者进展到终末期肾病（ESRD）的相关危险因素，筛查进展到ESRD的高风险人群，以早期预防。【方法】收集本院231例糖尿病肾脏疾病患者的临床资料，随访3年，据是否出现ESRD分为未进展到ESRD（133例）、ESRD组（98例）。使用分类树模型分析进展到ESRD相关危险因素，通过节点增益分析筛选进展到ESRD的高风险人群。【结果】从预测变量中筛选到4个重要解释变量：载脂蛋B（ApoB）、性别、糖尿病视网膜病变、收缩压；ApoB升高是DKD进展的重要的危险因素；ApoB＞1.14mmol/L的慢性肾脏病（CKD）3～4期DKD患者，3年进展到ESRD的概率是75.0%，如合并糖尿病视网膜病变，有79.7%的概率进展到ESRD。【结论】分类树模型能有效筛选并分析进展到ESRD危险因素，并识别高风险人群特征，有利于早期防治。

Classification Tree Model Analysis on Risk Factors of Diabetic Kidney Disease to Progress to ESRD for CKD3-4 Stages Patients

【Objective】To analyze the risk factors of progression to end-stage renal disease（ESRD）in patients with diabetic kidney disease（DKD），and screen the high-risk population for early prevention.【Methods】The clinical data of 231 patients with diabetic nephropathy in our hospital were collected and followed up for 3 years. According to whether ESRD occurred，they were divided into non-progressing ESRD group（133 cases）and ESRD group（98 cases）. Classification tree model was used to analyze the risk factors related to ESRD，and the high-risk population was screened by node gain analysis.【Results】Four important explanatory variables were screened out by the classification tree model from the candidate variables related to early renal damage，including apolipoprotein B（ApoB），gender，diabetic retinopathy，systemic blood pressure（SBP）. ApoB level was an important factor for DKD progression. For DKD patients with the chronic kidney disease （CKD）3~4 stages with ApoB > 1.14 mmol/L，the probability of progression to ESRD for 3 years was 75.0 %，and if at the same time with diabetic retinopathy，the probability was 79.7 %.【Conclusion】The classification tree model can analyze the risk factors of progression to ESRD in DKD patients effectively，to identify the characteristics of high-risk populations.