关键词: 高血压, 哈萨克族, Framingham高血压发病风险模型, 拟合度, 新疆, 牧民

Abstract: Background　The incidence of hypertension among Kazakh herdsmen in Xinjiang is high，so it is important to find effective methods to assess the risk of hypertension among Kazakh herdsmen and to intervene reasonably to prevent the occurrence of hypertension.Objective　To evaluate the accuracy and applicability of Framingham hypertension risk prediction model （hereinafter referred to as Framingham model）in predicting hypertension among Kazakh herdsmen in Xinjiang，in order to provide a reference for the establishment of risk prediction model for hypertension among Kazakh herdsmen in Xinjiang.Methods　In January 2008，5 327 Kazakh herdsmen in the Nanshan Pastoral Area of Urumqi County in Xinjiang were selected as research objects by stratified cluster random sampling method to establish the Nanshan dynamic cohort.Baseline data（including questionnaire and physical examination form）were collected，and research objects were followed up every 2 years for 3 times until November 2018，and the outcome event was the development of hypertension.The research objects were randomly divided into model queue（60% Kazakh herdsmen，3 196 cases）and validation queue（40% Kazakh herdsmen，2 131 cases）．According to the same method and predictive factors of the Framingham model，the model queue was adjusted and analyzed by the multi-factor Weibull regression analysis，that is，the adjusted model queue was the Framingham model in this study.The discriminatory power and ability of calibration were used to verify the predictive ability of the above Framingham model adjusted according to the data of this study to verify the risk of hypertension in the validation queue.Results　As of November 2018，there were 1，985 cases of hypertension among Kazakh herdsmen.A total of 16 897 person-years were followed up，and the incidence of hypertension was 11.75 cases per 100 person-years〔95%CI（11.27/100 person-years，12.24/100 person-years）〕．In validation queue，269 and 562 patients developed hypertension after two and four years of follow-up，respectively.The AUC of the adjusted Framingham model and the original Framingham model for verifying whether hypertension occurred in the validation queue after two years of follow-up were AUC adjusted Framingham model =0.647〔95%CI（0.624，0.670）〕and AUC original Framingham model =0.594〔95%CI（0.571，0.617）〕，and the difference was statistically significant（χ2=5.085，P<0.05）．The AUC of the adjusted Framingham model and the original Framingham model for verifying whether hypertension occurred after four years of follow-up in the validation queue were AUC adjusted Framingham model=0.609〔95%CI（0.590，0.628）〕and AUC original Framingham model=0.588〔95%CI（0.569，0.607）〕，and the difference was statistically significant（χ2=3.448，P<0.001）．In the adjusted Framingham model and the original Framingham model，the incidence of hypertension in the validation queue was compared with the actual incidence after two years of follow-up，and the Hosmer-lemeshow χ2（H-L χ2）test values were 697.68（P<0.05）and 802.40（P<0.05），respectively.In the adjusted Framingham model and the original Framingham model，the incidence of hypertension in the validation queue was compared with the actual incidence after four years of follow-up and the H-L χ2 test values were 682.61（P<0.05）and 832.82（P<0.05），respectively.Conclusion　The Framingham model has poor ability to distinguish and calibrate the risk of hypertension among Kazak herdsmen in Xinjiang，and it can not predict the risk of hypertension well.It is necessary to build a more suitable hypertension risk prediction model for this population.

Key words: Hypertension, Kazakh, Framingham hypertension risk prediction model, Fitting, Xinjiang, Herdsman