含免疫炎性指标的老年慢性心力衰竭患者肺部感染预测模型的构建及价值  

Construction and Value of Prediction Model of Pulmonary Infection in Elderly Patients with Chronic Heart Failure with Serum Immune-Inflammatory Index

作　　者：王肖雅 胡丹 兰超[3] 王丽杰[1] 王司 WANG Xiao-ya;HU Dan;LAN Chao;WANG Li-jie;WANG Si(Department of Geriatrics,the First Hospital of Baoding City,Baoding,Hebei 071000,China;Department of Cardiovascular Medicine,the First Hospital of Baoding City,Baoding,Hebei 071000,China;Department of Respiratory Medicine,the First Hospital of Baoding City,Baoding,Hebei 071000,China;Department of Infectious Diseases,the Affiliated Hospital of Hebei University,Baoding,Hebei 071000,China)

机构地区：[1]保定市第一医院老年病科,河北保定071000 [2]保定市第一医院心内科,河北保定071000 [3]保定市第一医院呼吸科,河北保定071000 [4]河北大学附属医院感染性疾病科,河北保定071000

出　　处：《临床误诊误治》2022年第11期59-63,共5页Clinical Misdiagnosis & Mistherapy

基　　金：保定市社发类项目(2041ZF061)。

摘　　要：目的探讨含免疫炎性指标的老年慢性心力衰竭患者肺部感染预测模型的构建及价值。方法选取2017年4月—2020年4月收治的老年慢性心力衰竭180例,统计肺部感染发生情况,分析老年慢性心力衰竭患者肺部感染的影响因素,构建列线图预测模型,并评价含免疫炎性指标(CD3+、CD4+、CD8+和肿瘤坏死因子-α、白细胞介素-6、C反应蛋白)的老年慢性心力衰竭患者肺部感染列线图预测模型临床获益。结果住院期间,老年慢性心力衰竭180例中46例并发肺部感染,134例未并发肺部感染。多因素Logistic回归分析结果显示,年龄、住院时间、合并糖尿病、合并慢性阻塞性肺疾病(COPD)、侵入性操作及免疫炎性指标均为老年慢性心力衰竭患者肺部感染的独立影响因素(P<0.01)。列线图预测模型预测老年慢性心力衰竭患者肺部感染的一致性指数为0.869(95%CI:0.804,0.919);决策曲线分析结果显示,当含免疫炎性指标的老年慢性心力衰竭患者肺部感染列线图预测模型预测值在0~0.9区间时,可提供附加临床获益。结论年龄、住院时间、合并糖尿病、合并COPD、侵入性操作及免疫炎性指标均为老年慢性心力衰竭患者肺部感染的独立影响因素,含免疫炎性指标的列线图预测模型可提高老年慢性心力衰竭患者肺部感染的预测准确性。Objective To explore the construction and value of the prediction model of pulmonary infection in elderly patients with chronic heart failure(CHF)containing immune-inflammatory indexes.Methods From April 2017 to April 2020,180 elderly patients with CHF were selected.The incidence of pulmonary infection was calculated,and the influencing factors of pulmonary infection in elderly patients with CHF were analyzed.The nomogram prediction model was constructed,and the clinical benefit of nomogram prediction model of pulmonary infection in elderly patients with CHF containing serum immune inflammatory indexes[CD3+,CD4+,CD8+,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)]was evaluated.Results During hospitalization,among 180 elderly patients with CHF,46 cases were complicated with pulmonary infection,and 134 cases were not complicated with pulmonary infection.Multivariate Logistic regression analysis showed that age,length of hospitalization,combined diabetes mellitus,combined chronic obstructive pulmonary disease(COPD),invasive procedures and immune inflammatory indexes were independent influencing factors of pulmonary infection in elderly patients with CHF(P<0.01).The consistency index of the nomogram prediction model in predicting pulmonary infection in elderly patients with CHF was 0.869(95%CI:0.804,0.919).The result of decision curve analysis showed that when the predicted value of the nomogram prediction model of pulmonary infection in elderly patients with CHF containing immune inflammatory indexes ranged from 0 to 0.9,it could provide additional clinical benefits.Conclusion Age,length of hospitalization,diabetes mellitus,COPD,invasive procedures and immune inflammatory indicators are all independent influencing factors of pulmonary infection in elderly patients with CHF.The nomogram prediction model with immune inflammatory indicators can improve the prediction accuracy of pulmonary infection in elderly patients with CHF.

关 键 词：心力衰竭 肺部感染 CD3+ CD4+ CD8+ 肿瘤坏死因子-α 白细胞介素-6 C反应蛋白 列线图 

分 类 号：R541.6[医药卫生—心血管疾病]