CN112216384A - Diabetic nephropathy risk assessment system - Google Patents
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- CN112216384A CN112216384A CN202011176544.5A CN202011176544A CN112216384A CN 112216384 A CN112216384 A CN 112216384A CN 202011176544 A CN202011176544 A CN 202011176544A CN 112216384 A CN112216384 A CN 112216384A
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Abstract
The invention discloses a diabetic nephropathy risk assessment system, which relates to the field of medical instruments, and comprises: the limiting device is used for determining whether to carry out diabetic nephropathy risk assessment limitation on the patient according to the medical history and the medical course of the patient; and the evaluation device is used for performing low-risk, medium-risk and high-risk evaluation on the diabetic nephropathy by using the diabetes related indexes and the indexes reflecting the damage of the kidney function if the diabetic nephropathy risk evaluation limit on the patient is determined not to be performed.
Description
Technical Field
The invention relates to the field of medical instruments, in particular to a diabetic nephropathy risk assessment system.
Background
The World Health Organization (WHO)1999 diabetes diagnostic criteria were as follows: firstly, adding more than or equal to 11.1mmol/L of blood sugar at any point to the symptoms of diabetes (polyuria, polydipsia and weight loss of unknown reasons); or ② diabetes symptom plus fasting blood sugar is more than or equal to 7.0 mmol/L; or ③ in the diabetes symptom plus Oral Glucose Tolerance Test (OGTT), 75g of glucose is taken orally for 2 hours, and the blood sugar is more than or equal to 11.1 mmol/L; and fourthly, the asymptomatic patients need to meet the standard for the blood sugar level for 2 times on different dates. Or self-report the history of diabetes diagnosed by a doctor or use hypoglycemic drugs for treatment. Patients with diabetes are late in onset age, slow in progression, overweight or obese, and those without significant insulin dependence are considered for diagnosis of type 2 diabetes.
The diagnosis standard of diabetic nephropathy adopts renal puncture histopathology, and the pathological diagnosis standard adopts Tervaert grading standard. Stage I: thickening of glomerular basement membrane: isolated glomerular basement membranes are thickened and show only slight non-specific changes under the light microscope, which do not meet the criteria of class II to class IV. II stage: mesenteric dilatation, mild (IIa) or severe (IIb): glomeruli can be classified as mild or severe mesangial expansion, nodular sclerosis (kimmolstee-Wilson lesions), and single glomerular sclerosis of no more than 50%. Grade III: tuberous sclerosis (Kimmelstiel-Wilson lesion): at least one nodular sclerosis of mesangial stroma (Kimmelstiel-Wilson), not reaching grade IV change. Stage IV: advanced diabetic glomerulosclerosis: greater than 50% of glomerular sclerosis, and other clinical or pathological evidence suggests that glomerular sclerosis is associated with diabetic nephropathy.
Because the gold standard of diabetic nephropathy diagnosis adopts ultrasound-guided renal biopsy, which belongs to invasive examination, the risks of bleeding, infection, perirenal hematoma and the like exist, and contraindications such as isolated kidney, severe heart failure, excessive obesity, incapability of matching examination of respiratory system diseases and the like exist.
The clinical evaluation indexes of diabetic nephropathy are mainly based on Microalbumin (MA) and microalbumin/creatinine (ACR) in urine kidney early damage examination, and the clinical evaluation indexes are not only renal dysfunction caused by other reasons. Compared with the kidney biopsy result, the evaluation index has false positive and false negative results in actual clinical work, namely, the possibility of missed diagnosis of diabetic nephropathy with other chronic kidney diseases, atypical diabetic nephropathy and earlier diabetic nephropathy is higher, and the possibility of misdiagnosis of other glomerular diseases is higher.
In the existing researches for evaluating the risk of diabetic nephropathy, the sectional integration is carried out based on three factors of the age of a patient, the diabetic course and the hypertension history, and the sensitivity and the specificity are lower; some diabetic nephropathy risk prediction formulas based on independent risk factors such as the course of diabetes, systolic pressure and glycosylated hemoglobin are constructed by using the kidney pathological results and clinical data of a few type 2 diabetic patients, but the formulas are complex, the research sample size is small, indexes such as systolic pressure and glycosylated hemoglobin have instability and other reasons, the result obtained on different dates and under different dietary conditions is possibly large in difference, and the clinical popularization is difficult; in addition, retrospective analysis is carried out on the renal puncture pathological examination result of a diabetic patient with a small amount of dominant proteinuria but without severe renal failure, and a differential diagnosis model of the diabetic nephropathy based on independent risk factors such as the diabetic course, the systolic blood pressure, the glycosylated hemoglobin and the like is constructed.
Disclosure of Invention
In order to solve the above problems, embodiments of the present invention provide a diabetic nephropathy risk assessment system.
According to an embodiment of the present invention, there is provided a diabetic nephropathy risk assessment system, including:
the limiting device is used for determining whether to carry out diabetic nephropathy risk assessment limitation on the patient according to the medical history and the medical course of the patient;
and the evaluation device is used for performing low-risk, medium-risk and high-risk evaluation on the diabetic nephropathy by using the diabetes related indexes and the indexes reflecting the damage of the kidney function if the diabetic nephropathy risk evaluation limit on the patient is determined not to be performed.
Preferably, the patient history and course of disease include diabetes with kidney damage, urinary system infection, kidney malignancy;
the limiting device comprises:
a diabetes-associated kidney injury detection module for determining whether there is diabetes-associated kidney injury by detecting diabetes-associated kidney injury of the patient;
a combined urinary system infection detection module for determining whether a combined urinary system infection exists by detecting a urinary system infection of the patient when it is determined that diabetes combined kidney damage exists;
the kidney malignant tumor detection module is used for detecting the kidney malignant tumor of the patient to determine whether the kidney malignant tumor exists or not when the diabetes mellitus combined with the kidney injury exists;
a restriction module for determining a restriction for risk assessment of diabetic nephropathy for the patient upon determining that there is no diabetes associated with kidney injury or at least one of associated urinary system infection and kidney malignancy.
Preferably, the diabetes-associated kidney injury detection module is specifically configured to determine whether there is type 2 diabetes-associated kidney injury by detecting type 2 diabetes-associated kidney injury of the patient.
Preferably, the patient history, course of disease further includes at least one of: combined with autoimmune diseases, combined with viral hepatitis B, drug-related kidney injury and acute kidney injury;
accordingly, the restriction device further comprises at least one of:
a combined autoimmune disease detection module for determining whether a combined autoimmune disease exists by detecting the combined autoimmune disease of the patient when it is determined that diabetes combined kidney injury exists;
a combined viral hepatitis B detection module for determining whether combined viral hepatitis B exists by detecting combined viral hepatitis B of the patient when it is determined that diabetes combined kidney injury exists;
a drug-related kidney injury detection module for determining whether a drug-related kidney injury exists by detecting a drug-related kidney injury of the patient when it is determined that diabetes mellitus complicated with kidney injury exists;
and the acute kidney injury detection module is used for detecting the acute kidney injury of the patient to determine whether the acute kidney injury exists or not when the diabetes mellitus combined kidney injury exists.
Preferably, the restriction module is further configured to determine to subject the patient to a diabetic nephropathy risk assessment restriction upon determining the presence of at least one of a combined autoimmune disease, a combined viral hepatitis b, a drug-related kidney injury, an acute kidney injury, or to not subject the patient to a diabetic nephropathy risk assessment restriction.
Preferably, the diabetes-related indicators include diabetic retinopathy and the course of diabetes; the indexes reflecting the kidney function damage comprise glomerular filtration rate estimation value, 24-hour urine protein quantification and hematuria.
Preferably, the evaluation device comprises:
a configuration module for diabetic retinopathy with a diabetic course of greater than or equal to 5 years and a glomerular filtration rate estimation value of less than 30ml/min/1.73m2The quantitative urine protein is more than or equal to 3g in 24 hours and the value is respectively set for anuria, so that the diabetic retinopathy, the diabetic course is more than or equal to 5 years, and the glomerular filtration rate estimated value is less than 30ml/min/1.73m2The ratio of the score to the total score for 24-hour urine protein quantification greater than or equal to 3g and hematuria is 2/6:1/6:1/6:1/6:1/6, respectively;
an index obtaining module, configured to obtain indexes of the patient including diabetic retinopathy, diabetic course, glomerular filtration rate, 24-hour urine protein quantification and hematuria, so as to determine whether the diabetic retinopathy of the patient is diseased, whether the diabetic course is greater than or equal to 5 years, and whether the estimated glomerular filtration rate is less than 30ml/min/1.73m2Whether the 24-hour urine protein quantification is greater than or equal to 3g and whether there is no hematuria;
a risk evaluation module for evaluating whether the patient has diabetic retinopathy, whether the diabetic course is greater than or equal to 5 years, and whether the glomerular filtration rate is less than 30ml/min/1.73m2The results of the determination of whether the 24-hour urine protein quantification is 3g or more and the anuresis, and the established diabetic retinopathy, the diabetic course of 5 years or more, and the glomerular filtration rate estimate of less than 30ml/min/1.73m2And quantifying the 24-hour urinary protein by a factor of 3g or more and a hematuria-free score, determining the diabetic nephropathy risk assessment score of the patient, and determining the diabetic nephropathy risk level of the patient to be low-risk, medium-risk or high-risk according to the diabetic nephropathy risk assessment score of the patient.
Preferably, the index obtaining module obtains the blood creatinine information, the age and the sex of the patient, and determines the glomerular filtration rate estimated value of the patient according to the blood creatinine information, the age and the sex of the patient.
Preferably, the risk assessment module is specifically configured to:
determining that the patient's diabetic nephropathy risk level is at low risk if the ratio of the patient's diabetic nephropathy risk assessment score to total score is less than or equal to 1/6;
determining the patient's diabetic nephropathy risk level as medium-risk if the patient's ratio of the diabetic nephropathy risk assessment score to the total score is greater than 1/6 and less than 4/6;
and if the ratio of the diabetic nephropathy risk assessment score to the total score of the patient is greater than or equal to 4/6, determining that the diabetic nephropathy risk level of the patient is at high risk.
The technical scheme provided by the embodiment of the invention has the following beneficial effects:
1. the system applies 5 clinical common indexes, obtains the evaluation score and the diabetic nephropathy risk level through calculation, belongs to a non-invasive technology, can avoid risks such as bleeding, infection and perirenal hematoma of patients, and is generally applicable to all patients with type 2 diabetes combined with renal injury.
2. The 5 clinical common indexes adopted by the system comprise diabetes related indexes and indexes reflecting kidney shape and function damage, and the indexes are set into two classification variables, so that the system is simple and clear, is easy to obtain clinically, and is convenient to remember and popularize and use clinically.
3. The 5 indexes in the system research have better stability, are not interfered by factors such as diet, exercise, antihypertensive drugs, hypoglycemic drugs, blood sugar control conditions and the like of patients, have higher sensitivity and specificity compared with the existing research, and have more accurate evaluation on diabetic nephropathy.
Drawings
FIG. 1 is a schematic structural diagram of a diabetic nephropathy risk assessment system according to an embodiment of the present invention;
FIG. 2 is a schematic structural diagram of a restriction device according to an embodiment of the present invention;
FIG. 3 is a schematic structural diagram of an evaluation apparatus according to another embodiment of the present invention;
FIG. 4 is a schematic workflow diagram of a diabetic nephropathy risk assessment system according to an embodiment of the present invention.
Detailed Description
The preferred embodiments of the present invention will be described in detail below with reference to the accompanying drawings, and it should be understood that the preferred embodiments described below are only for the purpose of illustrating and explaining the present invention, and are not to be construed as limiting the present invention.
Fig. 1 is a schematic structural diagram of a diabetic nephropathy risk assessment system according to an embodiment of the present invention, and as shown in fig. 1, the system includes a restriction device and an assessment device.
The limiting device is used for determining whether to carry out diabetic nephropathy risk assessment limitation on the patient according to the medical history and the medical course of the patient;
and the evaluation device is used for evaluating the low-risk, medium-risk and high-risk of the diabetic nephropathy by using the diabetes related indexes and the indexes reflecting the damage of the kidney function if the diabetic nephropathy risk evaluation limit of the patient is determined not to be carried out.
In one embodiment, the patient history and course of disease may include diabetes with renal impairment, urinary system infection, renal malignancy. Accordingly, the restriction device determines a diabetic nephropathy risk assessment restriction on the patient upon determining that there is no diabetic-associated renal injury, or at least one of an associated urinary system infection and a renal malignancy; conversely, when it is determined that there is diabetes combined with kidney damage and there is no presence of any of combined urinary system infection and kidney malignancy, it is determined that the patient is not subject to a diabetic nephropathy risk assessment limitation.
In another embodiment, the patient history and course may further include at least one of: combined with autoimmune disease, combined with viral hepatitis b, drug-related kidney injury and acute kidney injury. Accordingly, the restriction device determines to subject the patient to a diabetic nephropathy risk assessment restriction upon determining that there is no diabetes associated kidney injury or at least one of an associated urinary system infection, a renal malignancy, an associated autoimmune disease, an associated viral hepatitis b, a drug-related kidney injury, an acute kidney injury; determining not to subject the patient to diabetic nephropathy risk assessment limits when the presence of diabetes mellitus associated with kidney injury is determined and none of urinary system infection, renal malignancy, autoimmune disease, viral hepatitis b, drug-related kidney injury, acute kidney injury is associated.
Wherein the diabetes-associated kidney injury may be type 2 diabetes-associated kidney injury.
The index related to diabetes and the index reflecting the kidney function damage are both indexes which have good stability and are not interfered by factors such as diet, exercise, antihypertensive drugs, hypoglycemic drugs, blood sugar control conditions and the like of a patient in a short period of time, for example, the index related to diabetes can comprise diabetic retinopathy and the course of diabetes, and the index reflecting the kidney function damage can comprise an estimated glomerular filtration rate, 24-hour urine protein quantification and hematuria.
This system provides existing medical history, after the disease process at the patient, can judge whether this patient can carry out diabetic nephropathy risk assessment, and when judging this patient can carry out diabetic nephropathy risk assessment, utilize this patient's the relevant index of diabetes that has higher stability and does not receive patient's diet, motion, hypotensor, hypoglycemic medicine, blood sugar control condition and the impaired index of reflection kidney function, carry out diabetic nephropathy to this patient and carry out low-risk, well danger, high-risk assessment, each index easily acquires, the assessment result is more accurate, be convenient for clinical memory and clinical popularization and use, and do not have the wound to the patient.
Fig. 2 is a schematic structural diagram of a limiting device according to an embodiment of the present invention, as shown in fig. 2.
In one embodiment, the patient history, course of disease may include diabetes combined with kidney damage, combined urinary system infection, kidney malignancy, and accordingly, the restriction device may include a diabetes combined kidney damage detection module, a combined urinary system infection detection module, a kidney malignancy detection module, and a restriction module, wherein:
the diabetes-associated kidney injury detection module is used for determining whether diabetes-associated kidney injury exists or not, particularly determining whether diabetes-associated kidney injury exists or not by detecting the diabetes-associated kidney injury of the patient;
a urinary system infection detection module, configured to detect a urinary system infection of the patient when it is determined that there is a diabetes-associated kidney injury, and determine whether there is a urinary system infection (i.e., a diabetes-associated kidney injury-associated urinary system infection);
a renal malignancy detection module, configured to detect a renal malignancy of the patient when it is determined that the diabetes-associated renal injury exists, and determine whether the renal malignancy exists (i.e., the diabetes-associated renal injury-associated renal malignancy);
the restriction module is configured to determine to perform a diabetic nephropathy risk assessment restriction on the patient when it is determined that there is no diabetes-associated kidney injury or at least one of diabetes-associated urinary system infection and renal malignancy, and conversely, to not perform the diabetic nephropathy risk assessment restriction on the patient when it is determined that there is diabetes-associated kidney injury and no any one of diabetes-associated urinary system infection and renal malignancy.
The diabetes-associated kidney injury detection module, the urinary system infection detection module and the renal malignancy detection module may be detection devices arranged in detection departments of a hospital, and the detection result determined by each detection module may be a detection result already made by the hospital before the patient needs to perform diabetic nephropathy risk assessment.
The present embodiment may determine whether to perform a diabetic nephropathy risk assessment restriction on a patient based on the diabetes-associated kidney injury detection module, the urinary system infection-associated detection module, and the renal malignancy detection module. In order to improve the reliability of the diabetic nephropathy risk assessment, the present invention provides another embodiment, in which the patient history and course may further include at least one of the following: combined with autoimmune disease, combined with viral hepatitis b, drug-related kidney injury and acute kidney injury. Accordingly, the restriction device may further include at least one of:
a combined autoimmune disease detection module, configured to, when it is determined that there is diabetes combined with kidney injury, determine whether there is combined autoimmune disease (i.e., diabetes combined with kidney injury combined autoimmune disease) by detecting the combined autoimmune disease of the patient;
a combined viral hepatitis B detection module, configured to, when it is determined that there is a diabetic combined renal injury, determine whether there is combined viral hepatitis B (i.e., diabetic combined renal injury combined viral hepatitis B) by detecting the combined viral hepatitis B of the patient;
a drug-related kidney injury detection module, configured to, when it is determined that there is a diabetes-complicated kidney injury, determine whether there is a drug-related kidney injury (i.e., a diabetes-complicated kidney injury-complicated drug-related kidney injury) by detecting the drug-related kidney injury of the patient;
and the acute kidney injury detection module is used for determining whether acute kidney injury exists or not (namely diabetes mellitus and acute kidney injury) by detecting the acute kidney injury of the patient when the diabetes mellitus and the kidney injury exist.
In this embodiment, the restriction device determines that the patient is to be subjected to diabetic nephropathy risk assessment restriction when it is determined that there is no diabetic-associated renal injury, or at least one of an associated urinary system infection, a renal malignancy, an associated autoimmune disease, an associated viral hepatitis b, a drug-related renal injury, and an acute renal injury; otherwise, the patient is determined not to be subject to the diabetic nephropathy risk assessment restrictions. For example, when the restriction device comprises the diabetes-associated kidney injury detection module, the urinary system infection detection module, the kidney malignancy detection module, the hepatitis B virus detection module, and the drug-related kidney injury detection module, the restriction module can determine whether the patient has diabetes-associated kidney injury, diabetes-associated kidney injury-associated urinary system infection, diabetes-associated kidney injury-associated kidney malignancy, diabetes-associated kidney injury-associated hepatitis B, diabetes-associated kidney injury-associated drug-related kidney injury, upon determining that the patient does not have diabetes-associated kidney injury, or has at least one of diabetes-associated kidney injury-associated urinary system infection, diabetes-associated kidney injury-associated kidney malignancy, diabetes-associated kidney injury-associated viral hepatitis B, diabetes-associated kidney injury-associated drug-related kidney injury, and determining to carry out diabetic nephropathy risk assessment restriction on the patient, otherwise, determining not to carry out diabetic nephropathy risk assessment restriction on the patient when determining that the patient has the diabetic kidney injury and does not have the renal injury complicated by diabetes, urinary system infection complicated by the diabetic kidney injury, renal malignancy complicated by diabetes, viral hepatitis type B complicated by the diabetic kidney injury and renal injury related to a drug complicated by diabetes.
The detection modules can be detection devices arranged in detection departments of the hospital, and the detection results determined by the detection modules can be detection results already made by the hospital before the patient needs to perform diabetic nephropathy risk assessment. That is, the patient can determine whether to use the system of the present invention for risk assessment of diabetic nephropathy based on the determined medical history and course.
The above-mentioned limitations mainly refer to the inability to perform a diabetic nephropathy risk assessment on a patient using an assessment device.
Fig. 3 is a schematic structural diagram of an evaluation apparatus according to another embodiment of the present invention, and as shown in fig. 3, the evaluation apparatus may include a configuration module, an index obtaining module, and a risk evaluation module, where:
the configuration module is used for providing diabetic retinopathy, the diabetic course is more than or equal to 5 years, and the estimated value of the glomerular filtration rate is less than 30ml/min/1.73m224 hours, the urine protein is quantifiedSetting scores of 3g or more and anuria respectively to make diabetic retinopathy, diabetic course greater than or equal to 5 years, and glomerular filtration rate estimate less than 30ml/min/1.73m2The ratios of the score to the total score for 24-hour urine protein quantification of 3g or more and bloodless urine were 2/6:1/6:1/6:1/6:1/6, respectively, for example, set to 2 points, 1 point, respectively.
The index acquisition module is used for acquiring indexes of the patient including diabetic retinopathy, diabetic course, glomerular filtration rate estimated value, 24-hour urine protein quantification and hematuria to determine whether the diabetic retinopathy of the patient is pathological or not, whether the diabetic course is more than or equal to 5 years or not and whether the glomerular filtration rate estimated value is less than 30ml/min/1.73m or not2Whether the 24-hour urine protein quantification is greater than or equal to 3g and whether there is no hematuria; the index obtaining module can obtain the blood creatinine information, the age and the sex of the patient, and determine the glomerular filtration rate estimated value of the patient according to the blood creatinine information, the age and the sex of the patient.
The risk evaluation module is used for evaluating whether the diabetic retinopathy of the patient is pathological or not, whether the diabetic course is more than or equal to 5 years or not and whether the glomerular filtration rate estimated value is less than 30ml/min/1.73m or not2The results of the determination of whether the 24-hour urine protein quantification is 3g or more and the anuresis, and the established diabetic retinopathy, the diabetic course of 5 years or more, and the glomerular filtration rate estimate of less than 30ml/min/1.73m2And quantifying the 24-hour urinary protein by a factor of 3g or more and a hematuria-free score, determining the diabetic nephropathy risk assessment score of the patient, and determining the diabetic nephropathy risk level of the patient to be low-risk, medium-risk or high-risk according to the diabetic nephropathy risk assessment score of the patient. Specifically, if the ratio of the diabetic nephropathy risk assessment score to the total score of the patient is less than or equal to 1/6, determining the diabetic nephropathy risk level of the patient as low risk; determining the patient's diabetic nephropathy risk level as medium-risk if the patient's ratio of the diabetic nephropathy risk assessment score to the total score is greater than 1/6 and less than 4/6; if said patient suffers fromAnd if the ratio of the diabetic nephropathy risk assessment score to the total score of the patient is greater than or equal to 4/6, determining the diabetic nephropathy risk level of the patient as high risk.
The system sets the index as a binary variable, for example, a patient gets 2 points if the diabetic retinopathy exists, otherwise gets 0 point; if the diabetes course is more than or equal to 5 years, the score is 1, otherwise, the score is 0; if the glomerular filtration rate estimation value is less than 30ml/min/1.73m2If not, the score is 1, otherwise, the score is 0; if the quantity of the urine protein is more than or equal to 3g in 24 hours, 1 point is obtained, otherwise, 0 point is obtained; if there is no hematuria, 1 point is obtained, otherwise 0 point is obtained. By means of the setting, the diabetic nephropathy risk assessment score of the patient can be rapidly calculated, when the score is between 0 and 1 minute, the diabetic nephropathy risk level of the patient is determined to be low-risk, namely the possibility that the patient suffers from diabetic nephropathy is low, namely the possibility that the patient suffers from non-diabetic nephropathy is high, when the score is between 2 and 3 minutes, the diabetic nephropathy risk level of the patient is determined to be medium-risk, and when the score is between 4 and 6 minutes, the diabetic nephropathy risk level of the patient is determined to be high-risk, namely the possibility that the patient suffers from diabetic nephropathy is high. The system has simple calculation mode and is convenient to remember, popularize and use.
Fig. 4 is a schematic work flow chart of a diabetic nephropathy risk assessment system provided by the embodiment of the present invention, as shown in fig. 4, the flow chart is as follows:
the first step is as follows: before the evaluation device of the system is used for evaluating the diabetic nephropathy risk of a patient, whether the patient is a type 2 diabetes mellitus complicated kidney injury patient is determined, if so, whether the patient is complicated with urinary system infection, whether clear kidney malignant tumor exists, whether autoimmune disease is complicated, viral hepatitis B is complicated, clear drug-related kidney injury is clear, and acute kidney injury is determined in sequence.
It should be noted that the exclusion order includes, but is not limited to, the order indicated in fig. 4, that is, the change of the exclusion order does not affect the final result, and in the practical application, it can be determined that the diabetic nephropathy risk of the patient cannot be evaluated by the evaluation device of the present system as long as the patient is determined not to have type 2 diabetes with kidney injury, or the patient has any one of urinary system infection, definite renal malignancy, autoimmune disease, hepatitis b, drug-related kidney injury, and acute kidney injury.
The second step is that: and determining the score of each index of the patient according to the acquired diabetes related index of the patient, the index reflecting the renal function damage and the scores of the two classification variables set for each index.
In this embodiment, 2 points are obtained if there is diabetic retinopathy, otherwise 0 points are obtained; if the diabetes course is more than or equal to 5 years, the score is 1, otherwise, the score is 0; if the glomerular filtration rate estimation value is less than 30ml/min/1.73m2If not, the score is 1, otherwise, the score is 0; if the quantity of the urine protein is more than or equal to 3g in 24 hours, 1 point is obtained, otherwise, 0 point is obtained; if there is no hematuria, 1 point is obtained, otherwise 0 point is obtained.
After acquiring relevant indexes of diabetes including diabetic retinopathy and diabetic course of a patient and indexes reflecting renal function damage including glomerular filtration rate estimation value, 24-hour urine protein quantification and hematuria condition of the patient, setting conditions according to the score of each index, and determining the score of each index of the patient.
Among them, the index "Diabetic Retinopathy" (DR) adopted by the system can be confirmed by ophthalmologists using direct or indirect ophthalmoscopy fundus examination and/or fluorescein fundus angiography or fundus coherence tomography (OCTA) examination.
The index "glomerular filtration rate estimation value" (eGFR) adopted by the system can be estimated by using an mdrd (modified Diet in secondary Disease formulation) formula, namely, eGFR (186.3 × blood creatinine (mg/dl) -1.154 × age (year) -0.203 × (0.742 women).
The staging criteria for Chronic Kidney Disease (CKD) are shown in table 1 (part of medical institutional laboratory test reports directly show the index values) according to the staging criteria of global kidney disease improvement prognosis organization (KDIGO) 2012.
Table 1. staging standard table for chronic kidney disease.
Wherein, the index adopted by the system, namely '24-hour urine protein quantification' (24h UTP), has the unit of g/24h, and refers to the total protein content in all urine samples within 24 continuous hours.
The index of the system is that the index of 'hematuria' is that the result of the urine occult blood examination in the urine routine examination is "+" - "+ + + + +", which are defined as hematuria and "-" is defined as no hematuria.
The third step: and determining the risk assessment score of the diabetic nephropathy of the patient according to the score of each index of the patient, and determining the risk level of the diabetic nephropathy of the patient to be low-risk, medium-risk or high-risk according to the risk assessment score of the diabetic nephropathy of the patient and a preset score range corresponding to the risk level of the diabetic nephropathy.
In this embodiment, when the score is between 0 and 1 minute, the diabetic nephropathy risk level of the patient is determined to be low risk, when the score is between 2 and 3 minutes, the diabetic nephropathy risk level of the patient is determined to be medium risk, and when the score is between 4 and 6 minutes, the diabetic nephropathy risk level of the patient is determined to be high risk.
Compared with the existing evaluation method, the method can more accurately reduce the occurrence of missed diagnosis and misdiagnosis, the sensitivity of the method for diagnosing the diabetic nephropathy reaches 0.957, the specificity reaches 0.725, and the area under the curve (AUC) reaches 0.924.
In summary, the embodiments of the present invention have the following technical effects:
1. according to the invention, through risk assessment of diabetic nephropathy, especially type 2 diabetic nephropathy, the accuracy of a clinician for identifying diabetic nephropathy and non-diabetic nephropathy is improved, the missed diagnosis rate and the misdiagnosis rate are reduced, the pain, the risk and the medical cost of a patient are reduced, and unnecessary medical expenditure of the country is reduced. Meanwhile, valuable diagnosis and treatment suggestions are given to patients who are difficult to perform renal biopsy, and clinical work is guided to be further promoted.
2. The invention selects simple, stable and easily obtained clinical indexes for analysis, thereby increasing the feasibility of diagnosis for basic level diagnosis and treatment institutions;
3. the simple risk assessment system is established by a statistical method, the accuracy is high, and the popularization and the promotion of medical institutions at all levels are facilitated;
4. the invention carries out clinical research based on the pathological diagnosis of the kidney, and the obtained risk assessment conclusion has more confidence.
Although the present invention has been described in detail hereinabove, the present invention is not limited thereto, and various modifications can be made by those skilled in the art in light of the principle of the present invention. Thus, modifications made in accordance with the principles of the present invention should be understood to fall within the scope of the present invention.
Claims (9)
1. A diabetic nephropathy risk assessment system, the system comprising:
the limiting device is used for determining whether to carry out diabetic nephropathy risk assessment limitation on the patient according to the medical history and the medical course of the patient;
and the evaluation device is used for performing low-risk, medium-risk and high-risk evaluation on the diabetic nephropathy by using the diabetes related indexes and the indexes reflecting the damage of the kidney function if the diabetic nephropathy risk evaluation limit on the patient is determined not to be performed.
2. The system of claim 1, wherein the patient history, course of disease includes diabetes with kidney damage, urinary system infection, kidney malignancy;
the limiting device comprises:
a diabetes-associated kidney injury detection module for determining whether there is diabetes-associated kidney injury by detecting diabetes-associated kidney injury of the patient;
a combined urinary system infection detection module for determining whether a combined urinary system infection exists by detecting a urinary system infection of the patient when it is determined that diabetes combined kidney damage exists;
the kidney malignant tumor detection module is used for detecting the kidney malignant tumor of the patient to determine whether the kidney malignant tumor exists or not when the diabetes mellitus combined with the kidney injury exists;
a restriction module for determining a restriction for risk assessment of diabetic nephropathy for the patient upon determining that there is no diabetes associated with kidney injury or at least one of associated urinary system infection and kidney malignancy.
3. The system of claim 2, wherein the diabetes-associated kidney injury detection module is specifically configured to determine whether there is type 2 diabetes-associated kidney injury by detecting type 2 diabetes-associated kidney injury in the patient.
4. The system of claim 2 or 3, wherein the patient history, course further comprises at least one of: combined with autoimmune diseases, combined with viral hepatitis B, drug-related kidney injury and acute kidney injury;
accordingly, the restriction device further comprises at least one of:
a combined autoimmune disease detection module for determining whether a combined autoimmune disease exists by detecting the combined autoimmune disease of the patient when it is determined that diabetes combined kidney injury exists;
a combined viral hepatitis B detection module for determining whether combined viral hepatitis B exists by detecting combined viral hepatitis B of the patient when it is determined that diabetes combined kidney injury exists;
a drug-related kidney injury detection module for determining whether a drug-related kidney injury exists by detecting a drug-related kidney injury of the patient when it is determined that diabetes mellitus complicated with kidney injury exists;
and the acute kidney injury detection module is used for detecting the acute kidney injury of the patient to determine whether the acute kidney injury exists or not when the diabetes mellitus combined kidney injury exists.
5. The system of claim 4, wherein the restriction module is further configured to determine to subject the patient to a diabetic nephropathy risk assessment restriction upon determining the presence of at least one of a combined autoimmune disease, a combined viral hepatitis B, a drug-related kidney injury, an acute kidney injury, or to not subject the patient to a diabetic nephropathy risk assessment restriction.
6. The system of claim 1,
the diabetes related indexes comprise diabetic retinopathy and the diabetic course;
the indexes reflecting the kidney function damage comprise glomerular filtration rate estimation value, 24-hour urine protein quantification and hematuria.
7. The system of claim 6, wherein the evaluation device comprises:
a configuration module for diabetic retinopathy with a diabetic course of greater than or equal to 5 years and a glomerular filtration rate estimation value of less than 30ml/min/1.73m2The quantitative urine protein is more than or equal to 3g in 24 hours and the value is respectively set for anuria, so that the diabetic retinopathy, the diabetic course is more than or equal to 5 years, and the glomerular filtration rate estimated value is less than 30ml/min/1.73m2The ratio of the score to the total score for 24-hour urine protein quantification greater than or equal to 3g and hematuria is 2/6:1/6:1/6:1/6:1/6, respectively;
an index obtaining module, configured to obtain indexes of the patient including diabetic retinopathy, diabetic course, glomerular filtration rate estimation value, 24-hour urine protein quantification and hematuria to determine whether the diabetic retinopathy of the patient is diseased, and whether the diabetic course is greater than or equal toEqual to 5 years, and whether the glomerular filtration rate estimation value is less than 30ml/min/1.73m2Whether the 24-hour urine protein quantification is greater than or equal to 3g and whether there is no hematuria;
a risk evaluation module for evaluating whether the patient has diabetic retinopathy, whether the diabetic course is greater than or equal to 5 years, and whether the glomerular filtration rate is less than 30ml/min/1.73m2The results of the determination of whether the 24-hour urine protein quantification is 3g or more and the anuresis, and the established diabetic retinopathy, the diabetic course of 5 years or more, and the glomerular filtration rate estimate of less than 30ml/min/1.73m2And quantifying the 24-hour urinary protein by a factor of 3g or more and a hematuria-free score, determining the diabetic nephropathy risk assessment score of the patient, and determining the diabetic nephropathy risk level of the patient to be low-risk, medium-risk or high-risk according to the diabetic nephropathy risk assessment score of the patient.
8. The system of claim 7, wherein the index acquisition module acquires the patient's blood creatinine information, age, and gender and determines the patient's glomerular filtration rate estimate based on the patient's blood creatinine information, age, and gender.
9. The system of claim 7, wherein the risk assessment module is specifically configured to:
determining that the patient's diabetic nephropathy risk level is at low risk if the ratio of the patient's diabetic nephropathy risk assessment score to total score is less than or equal to 1/6;
determining the patient's diabetic nephropathy risk level as medium-risk if the patient's ratio of the diabetic nephropathy risk assessment score to the total score is greater than 1/6 and less than 4/6;
and if the ratio of the diabetic nephropathy risk assessment score to the total score of the patient is greater than or equal to 4/6, determining that the diabetic nephropathy risk level of the patient is at high risk.
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