甲状腺功能亢进症患者并发心房颤动的影响因素及其风险预测列线图模型构建研究  

Influencing Factors and Construction of Risk Prediction Nomogram Model of Atrial Fibrillation in Patients with Hyperthyroidism

作　　者：陈秋景 梁家燕 覃艳斐 韦文合[1] 莫昌干[2] CHEN Qiujing;LIANG Jiayan;QIN Yanfei;WEI Wenhe;MO Changgan(Department of Endocrinology,the People's Hospital of Hechi,Hechi 547000,China;Department of Cardiovascular Medicine,the People's Hospital of Hechi,Hechi 547000,China)

机构地区：[1]广西壮族自治区河池市人民医院内分泌科,547000 [2]广西壮族自治区河池市人民医院心内科,547000

出　　处：《实用心脑肺血管病杂志》2021年第8期22-28,共7页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：河池市科技计划项目(河科AB193601)。

摘　　要：背景目前临床关于甲状腺功能亢进症(以下简称甲亢)患者并发心房颤动的危险因素及相关预测模型的研究较少,临床缺乏一种易掌握、简单高效的预测方法。目的探讨甲亢患者并发心房颤动的影响因素,并构建其风险预测列线图模型,以期为临床诊疗提供参考依据。方法回顾性分析2018年2月—2020年11月河池市人民医院收治的564例甲亢患者的临床资料。收集患者首次入院时的基线资料。采用多因素Logistic回归分析探讨甲亢患者并发心房颤动的影响因素;采用R语言(R 4.0.3软件包)构建风险预测列线图模型,采用Bootstrap方法(自采样1000次)进行内部验证,计算一致性指数(CI),采用校正曲线和受试者工作特征(ROC)曲线评价列线图模型对甲亢患者并发心房颤动的预测价值。结果在564例甲亢患者中,92例并发心房颤动,设为观察组,心房颤动发生率为16.31%;472例未并发心房颤动,设为对照组。观察组患者年龄、左心室舒张末期内径(LVEDD)、左心室内径(LAD)大于对照组,吸烟者占比及血清抗甲状腺过氧化物酶抗体(anti-TPO)、超敏C反应蛋白(hs-CRP)、N末端脑钠肽前体(NT-proBNP)水平高于对照组(P<0.05)。多因素Logistic回归分析结果显示,年龄〔OR=1.051,95%CI(1.013,1.091)〕、吸烟〔OR=5.166,95%CI(2.292,11.644)〕、LVEDD〔OR=1.167,95%CI(1.112,1.226)〕、LAD〔OR=1.567,95%CI(1.388,1.769)〕及血清anti-TPO〔OR=1.005,95%CI(1.003,1.008)〕、hs-CRP〔OR=1.297,95%CI(1.141,1.475)〕、NT-proBNP〔OR=1.006,95%CI(1.003,1.008)〕水平是甲亢患者并发心房颤动的独立影响因素(P<0.05)。将甲亢患者并发心房颤动的影响因素作为预测因素,构建甲亢患者并发心房颤动的风险预测列线图模型,内部验证结果显示:CI为0.954;Hosmer-Lemeshow检验结果显示,该列线图模型的风险预测值与实际观测值的预测偏差比较,差异无统计学意义(χ^(2)=1.712,P=0.954);列线图模型预测甲亢患者并Background At present,there are few clinical studies on the risk factors and related prediction models of atrial fibrillation in patients with hyperthyroidism,and there is a lack of an easy to master,simple and efficient prediction method in clinic.Objective To discuss the influencing factors of atrial fibrillation in patients with hyperthyroidism,and construct a Nomogram model,in order to provide a reference for clinical diagnosis and treatment.Methods Clinical data of 564 patients with hyperthyroidism admitted to the People's Hospital of Hechi from February 2018 to November 2020 were retrospective analysed.Baseline data at the time of the patient's first admission were collected.Multivariate Logistic regression analysis was used to explore the influencing factors of atrial fibrillation in patients with hyperthyroidism;R language(R 4.0.3 software package)was used to construct a Nomogram model,Bootstrap method(self-sampling 1000 times)was used for internal verification,and calculated the consistency index(CI),and calibration curve and receiver operating characteristic curve(ROC curve)were drawn to evaluate the predictive value of the Nomogram model for patients with hyperthyroidism complicated with atrial fibrillation.Results Among the 564 patients with hyperthyroidism,92 patients with atrial fibrillation were set as the observation group,and the incidence of atrial fibrillation was 16.31%;472 patients without atrial fibrillation were set as the control group.Age,left ventricular end diastolic diameter(LVEDD),left ventricular diameter(LAD)of the observation group were larger than those of the control group,the proportion of smokers,and the serum anti-thyroid peroxidase antibody(anti-TPO),high sensitivity C-reactive protein(hs-CRP)and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels were higher than those of the control group(P<0.05).Multivariate Logistic regression analysis results showed that,age[OR=1.051,95%CI(1.013,1.091)],smoking[OR=5.166,95%CI(2.292,11.644)],LVEDD[OR=1.167,95%CI(1.112,1.226)],LAD[OR

关 键 词：甲状腺功能亢进症 心房颤动 影响因素分析 列线图 

分 类 号：R581.1[医药卫生—内分泌] R541.75[医药卫生—内科学]