建立动脉性肺动脉高压发展为右心衰的列线图预测模型  

To establish a nomogram prediction model for development of right heart failure in patients with pulmonary arterial hypertension

作　　者：吾拉尔·阿德力 娜孜拉·努尔兰 阿提开木·吾布力[2] 麦尔哈巴·雪热提 艾尼娃尔·艾克木 迪丽努尔·买买提依明[1] Wulaer Adeli;Nazila Nerlan;Atikaimu Wubuli;Maierhaba Xuereti;Ainiwaer Aikemu;Dilinuer Maimaitiyiming(Department of General Cardiology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;College of Public Health,Xinjiang Medical University,Urumqi 830017,China;College of Xinjiang Uyghur Medicine,Hotan Xinjiang 848000,China)

机构地区：[1]新疆医科大学第一附属医院综合心脏内科,乌鲁木齐830054 [2]新疆医科大学公共卫生学院,乌鲁木齐830017 [3]新疆维吾尔医学专科学校,新疆和田848000

出　　处：《新疆医科大学学报》2023年第4期453-459,共7页Journal of Xinjiang Medical University

基　　金：国家自然科学基金(81660695);天山创新团队计划项目(2020D14032)。

摘　　要：目的明确动脉性肺动脉高压(PAH)患者发生右心衰竭(RHF)的危险因素并构建预测PAH患者发生RHF的列线图模型。方法回顾性分析2014年1月-2021年12月,特发性肺动脉高压(IPAH)、系统性红斑狼疮相关性肺动脉高压(SLE-PAH)患者63例,分为PAH合并RHF组26例,PAH不合并RHF组37例。分析两组患者一般临床资料、实验室指标、心脏超声指标,采用单因素与多因素Logistic回归分析得到PAH发生RHF的独立危险因素。应用R语言软件(R 4.2.1)构建列线图预测模型,并对该模型进行验证。结果与PAH不合并RHF组相比,PAH合并RHF组年龄小,淋巴细胞计数、单核细胞计数升高,高密度脂蛋白(HDL)、低密度脂蛋白降低,肺动脉压力(PASP)增大,左室舒张末期内径降低(P<0.05)。回归分析结果显示,HDL、左室舒张末期内径、PASP是PAH发生RHF的独立危险因素。利用上述指标构建列线图模型,经Bootstrap重复抽样1000次内部验证法,发现预测值同实测值基本一致,表示本研究建立的预测模型一致性良好;计算出C-index为0.897(95%CI:0.815~0.979),具有良好的区分度。预测模型的ROC曲线下面积为0.898,预测效能高。结论HDL降低、左室舒张末期内径降低、PASP升高的PAH患者发生RHF的风险显著升高,本研究构建的列线图模型有助于评估PAH患者发生RHF的风险。Objective To identify the risk factors in developing right heart failure(RHF)in patients with pulmonary arterial hypertension(PAH)and construct a nomogram model for predicting risk of developing RHF in PAH patients.Methods During the span from January 2014 to December 2021,63 patients with idiopathic pulmonary arterial hypertension(IPAH)and systemic lupus erythematosus associated pulmonary arterial hypertension(SLE-PAH)were retrospectively analyzed.The patients were divided into 26 cases of PAH patients with RHF and 37 cases without.By analyzing the general clinical data,the laboratory indexes and cardiac ultrasound indexes of the two groups and the independent risk factors for RHF in PAH patients were obtained by univariate and multivariate Logistic regression analysis.The R language software(R4.2.1)was used to build and verify the nomogram prediction model.Results Compared with the PAH without RHF group,the PAH with RHF group was younger,the lymphocyte count and monocyte count increased,the high-density lipoprotein(HDL)and low-density lipoprotein decreased,the pulmonary artery pressure(PASP)increased,and the left ventricular end diastolic diameter decreased(P<0.05).The regression analysis showed that high-density lipoprotein(HDL),left ventricular(LV)end diastolic diameter and pulmonary artery systolic pressure were independent in development RHF in PAH patients.The nomograph model was constructed with using the indicators above,and the internal validation method was validated by Bootstrap repeated sampling 1000 times.It was found that the predicted value was mostly consistent with the measured value,indicating that the prediction model established in this study showed with high consistency;The calculated C-index was 0.897(95%CI:0.815~0.979),which had good discrimination.The area under the ROC curve of the prediction model was 0.898 with high prediction efficiency.Conclusion The risk of developing RHF in PAH patients with decreased high-density lipoprotein,decreased left ventricular end diastolic diameter,and el

关 键 词：动脉性肺动脉高压 右心衰竭 高密度脂蛋白 左室舒张末期内径 

分 类 号：R541.9[医药卫生—心血管疾病]