异质血压治疗对2型糖尿病认知衰退的影响:一项随机临床试验的机器学习分析
Xuan Zhao1,2, Xiaoli Xu1,2, Siyu Wang1,2
1Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Diabetes, obesity & metabolism
|December 26, 2024
概括
密集的血压治疗有利于选择2型糖尿病患者的认知衰退. 机器学习确定了具有高尿白蛋白与肌素比率或特定心血管风险因素的子组,这些子组经历了显著的认知益处.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學.
- 神经学 神经学
- 内分泌学 在内分泌学.
- 数据科学数据科学数据科学
背景情况:
- 2型糖尿病与认知能力下降的风险增加有关.
- 血压管理在糖尿病护理中至关重要,但对认知健康的最佳目标仍在争论中.
- 确定从密集血压 (BP) 治疗中获益最多的患者子组对于个性化医疗至关重要.
研究的目的:
- 通过机器学习识别2型糖尿病患者的密集血压治疗与认知益处相关的患者特征.
- 探索密集血压控制对认知衰退的异质治疗效应.
主要方法:
- 利用了来自ACCORD-MIND研究的1349名2型糖尿病患者的数据.
- 使用机器学习 (因果森林和因果树模型),与糖尿病和认知相关的79个变量.
- 强化血压治疗 (静态血压<120 mmHg) 与标准治疗 (静态血压<140 mmHg) 的比较.
主要成果:
- 四个变量尿中的白蛋白与肌素比率 (UACR),弗拉明汉10年心血管风险评分 (FRS),甘油三 (TG) 和糖尿病持续时间确定了五个子组.
- 1小组 (高UACR≥65 mg/g) 显示,在强化血压治疗下,认知能力下降的绝对风险降低15.36%.
- 第二小组 (低UACR<65 mg/g,高FRS≥26%,低TG<2.3 mmol/L,长期糖尿病持续时间≥9年) 显示14.74%的绝对风险降低.
结论:
- 患有2型糖尿病和高UACR的患者可能会从密集的BP治疗中从认知上受益.
- 具有低UACR,低TG,高心血管风险和长时间糖尿病持续时间的特定亚组也显示出认知益处.
- 这些发现支持个性化BP管理策略,以保持糖尿病患者的认知功能.
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