慢性阻塞性肺疾病致心功能不全的列线图评价指标研究  

Evaluation index of cardiac insufficiency induced by chronic obstructive pulmonary diseases based on nomogram

作　　者：洪雁[1] 石宝平[1] 程克文[1] 

机构地区：[1]复旦大学附属华山医院宝山分院呼吸内科,上海200431

出　　处：《海军医学杂志》2016年第1期27-29,共3页Journal of Navy Medicine

摘　　要：目的研究慢性阻塞性肺疾病（COPD）致心功能不全的评价指标。方法以2015年1-6月就诊的127例COPD患者为研究对象,收集住院期间临床资料和主要检查结果。采用单因素与多因素非条件的Logistic方法分析COPD致心功能不全的危险因素,并通过列线图的方法来估计每位患者发生心功能不全的概率。结果 p H值和PCO_2值的第一主成分（blood）、脑钠肽、诊断分级和心电图等变量有统计学意义（P〈0.05）。多因素Logistic分析显示blood（OR=1.35,95%CI：0.74~2.49）,脑钠肽（OR=1.06,95%CI：1.00~1.10）,传导阻滞比正常（OR=12.58,95%CI：2.19~72.17）,COPD4级比3级（OR=1.29,95%CI：0.39~4.20）是COPD致心功能不全的危险因素。AUC（area under curve）值为0.794（95%CI：0.69~0.90）。结论 p H值、PCO_2、BNP值增高、心电图显示传导阻滞和COPD分级高是COPD致心功能不全不良预后的危险因素。因此,针对以上检查、应当给诊断的患者相应处理,以降低COPD致心功能不全的发生率。Objective To investigate the evaluation index of cardiac insufficiency induced by chronic obstructive pulmonary diseases （COPD）. Methods One hundred and twenty - seven patients with COPD, who sought medical care from January to June, 2015 at our hospital, were used as research subjects. Clinical medical data and main detection results during hospitalization were collected for the study. Main risk factors of cardiac insufficiency induced by COPD were analyzed by using non - conditional single factor and multi - factor Logistic method, and the probability of cardiac insufficiency occurred in each patient was estimated by nomogram. Results There was statistical significance in the variations of pH and PCO2 values of the first main component （blood）, BNP, diagnostic classification and ECG（ P 〈0. 05）. Multivariate Logistic regression analysis indicated the following results ： blood（ OR = 1.35, 95% CI：0.74 - 2.49）, BNP （OR = 1.06, 95% CI- 1.00 - 1.10）, conduction block ratio（OR = 12.58, 95% CI：2. 19 -72. 17）and COPD stage 4 versus stage 3 （ OR = 1.29 , 95% CI：0.39 - 4.20）, which were all risk factors inducing cardiac insufficiency. Area under curve （AUC） value was 0. 794（95% CI：0.69- 0.90）. Conclusion The values of pH, PCO2 and BNP were elevated. ECG diagram indicated that conduction block and high grade of COPD were all risk factors of poor prognosis of cardiac insufficiency induced by COPD. For this reason, appropri- ate treatment should be implemented on the basis of above detections, so as to reduce incidence of cardiac insufficiency induced by COPD.

关 键 词：慢性阻塞性肺疾病 心功能不全 LOGISTIC回归分析 列线图 

分 类 号：R563[医药卫生—呼吸系统]