COMPERA 2.0评分模型在中国动脉性肺动脉高压患者预后评估中的应用价值  

Evaluation effect of COMPERA 2.0 risk assessment model on prognosis of Chinese patients with pulmonary arterial hypertension

作　　者：梁砚薷 杨逸成 杨倍蓝 曾绮娴[1] 刘冰洋 赵青[1] 罗勤[1] 赵智慧[1] 杨涛[1] 柳志红[1] 熊长明 Liang Yanru;Yang Yicheng;Yang Beilan;Zeng Qixian;Liu Bingyang;Zhao Qing;Luo Qin;Zhao Zhihui;Yang Tao;Liu Zhihong;Xiong Changming(Center of Pulmonary Vascular Disease,National Center for Cardiovascular Disease,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院呼吸与肺血管疾病诊治中心,北京100037

出　　处：《中华医学杂志》2023年第18期1410-1416,共7页National Medical Journal of China

基　　金：首都卫生发展科研专项(2020-2-4035);中国医学科学院医学与健康科技创新工程2021年临床与转化医学研究专项(2021-I2M-C&T-A-009);国家高水平医院临床科研项目(2022-GSP-TS-6.2022-2024)

摘　　要：目的研究COMPERA 2.0评分模型在中国动脉性肺动脉高压(PAH)患者预后评估中的应用价值。方法回顾性纳入2019年4月至2022年3月于中国医学科学院阜外医院住院的初诊PAH患者,根据COMPERA 2.0评分模型将患者分为低危组、中低危组、中高危组和高危组。通过门诊或电话进行随访,主要研究终点定义为全因死亡、心力衰竭和临床症状加重组合成的复合终点。采用Kaplan-Meier法进行生存分析,并用log-rank趋势检验分析不同组别的预后差异,运用多因素Cox比例回归模型分析COMPERA 2.0评分与PAH患者预后的关联。结果共纳入951例PAH患者,年龄[M(Q_(1),Q_(3))]为35(28,47)岁,女性706例(74.2%)。低危组328例(34.5%),中低危组264例(27.8%),中高危组193例(20.3%),高危组166例(17.5%)。随访时间[M(Q_(1),Q_(3))]为1.8(1.0,2.8)年。低危组、中低危组、中高危组和高危组PAH患者复合终点发生率分别为12.8%(42/328)、21.2%(56/264)、28.5%(55/193)、42.8%(71/166),随危险分层上升呈升高趋势(P<0.001)。多因素Cox回归比例风险模型分析结果显示,高COMPERA 2.0评分与PAH患者主要终点的风险增加关联有统计学意义(HR=1.801,95%CI:1.254~2.588,P=0.001)。结论COMPERA 2.0评分模型是一个评估中国PAH初诊患者预后的简易且有效的工具。Objectives To clarify the evaluation effect of COMPERA 2.0 risk assessment model on prognosis of pulmonary arterial hypertension(PAH)in China.Methods Patients with newly diagnosed PAH admitted in Fuwai hospital between April 2019 and March 2022 were enrolled retrospectively and divided in low,intermediate-low,intermediate-high and high strata by scores of COMPERA 2.0 risk assessment model.All the patients were followed up by clinic or telephone.The primary endpoint was defined as a composite of all-cause mortality,exacerbated heart failure and aggravated symptoms.Kaplan-Meier analysis and log-rank trend test were used to determine the risk of endpoints among the 4 groups.Multivariate Cox proportional hazards regression were used to analyze the association between COMPERA 2.0 scores and prognosis in patients with PAH.Results A total of 951 patients with PAH were enrolled in this study.The age[M(Q_(1),Q_(3))]of the patients was 35(28,47)years,of which 706 cases(74.2%)were females.A total of 328 cases(34.5%)were assigned in low strata,264 cases(27.8%)in intermediate-low strata,193 cases(20.3%)in intermediate-high strata,and 166 cases(17.5%)in high strata.During the duration[M(Q_(1),Q_(3))]of follow-up after discharge of 1.8(1.0,2.8)years,the primary endpoint was occurred in 12.8%(42/328),21.2%(56/264),28.5%(55/193)and 42.8%(71/166)of low,intermediate-low,intermediate-high and high strata,respectively.The rates of primary endpoint were significantly increased with strata rising(P<0.001).Multivariate Cox proportional hazards regression showed that COMPERA 2.0 risk scores were associated with the primary endpoints in PAH patients(HR=1.801,95%CI:1.254-2.588,P=0.001)after adjusting confounders.Conclusion COMPERA 2.0 risk assessment model is a simple and effective tool for evaluating the prognosis of newly diagnosed PAH patients in China.

关 键 词：肺动脉 动脉性肺动脉高压 COMPERA 2.0评分模型 风险预测 回顾性队列研究 

分 类 号：R544.1[医药卫生—心血管疾病]