原发性醛固酮增多症患者术后高血压未治愈风险预测列线图模型的构建及其评价  

Construction and evaluation of nomogram model for predicting the risk of untreated hypertension in patients with primary hyperaldosteronism after surgery

作　　者：陈茜 孙兴兰[1] 胡婷英 万佳[1] 陈静[1] 陈颖 张盼 CHEN Qian;SUN Xinglan;HU Tingying;WAN Jia;CHEN Jing;CHEN Ying;ZHANG Pan(The Second Affi liated Hospital of Nanchang University,Nanchang,330000,China)

机构地区：[1]南昌大学第二附属医院,江西省南昌市330000

出　　处：《护理实践与研究》2023年第16期2369-2376,共8页Nursing Practice and Research

基　　金：江西省教育厅科学技术研究项目(编号:GJJ2200246)。

摘　　要：目的探讨原发性醛固酮增多症(primary aldosteronism,PA)患者术后高血压未治愈的影响因素,并构建其列线图风险预测模型。方法选取2018年1月—2022年1月在医院收治的行经皮超选择性肾上腺动脉栓塞术(super-selective adrenal arterial embolization,SAAE)的PA患者95例。收集患者电子病历系统的临床资料,根据患者术后高血压有无治愈进行分组,分为治愈组和未治愈组。比较两组患者的临床资料,并采用单因素分析相关影响因素,利用多因素Logistic回归分析建立列线图风险预测模型,采用ROC曲线下面积检验模型预测效果。结果其中治愈组61例(64.21%),未治愈组34例(35.79%)。多因素分析结果显示,两组患者性别(OR=278.745,95%CI:6.540~11880.659,P=0.003)、腰围(OR=1.261,95%CI:1.060~1.502,P=0.009)、合并心脑血管疾病(OR=222.908,95%CI:3.650~13614.182,P=0.010)、术前高血压药物种类数(OR=1.310,95%CI:1.097~1.564,P=0.037)为PA患者术后所致高血压未治愈的独立影响因素。在此基础上建立其列线图风险预测模型。其ROC曲线下面积为0.968(95%CI:0.937~1.000,P<0.001),灵敏度为0.882,特异度为0.984,Youden指数为0.866。结论患者性别、腰围、是否合并心脑血管疾病、术前高血压药物种类数是行SAAE的PA患者术后高血压未治愈发生的独立影响因素。以此构建的预测模型可有效预测PA患者术后高血压状态,为医护人员早期筛查PA术后高血压未治愈高危患者提供参考依据。Objective To explore the risk factors of postoperative uncured hypertension in primary aldosteronism(PA)patients,and construct a nomogram risk prediction model.Methods To select 95 PA patients who underwent percutaneous super-selective adrenal arterial embolization(SAAE)in the hospital from January 2018 to January 2022.We collected clinical data from the electronic medical record system of patients,and divided them into cured group and uncured group according to whether the postoperative hypertension was cured or not.The clinical data of the two groups of patients were compared,and the relevant influencing factors were analyzed by univariate analysis.The risk prediction model of the nomogram was established by multivariate Logistic regression analysis,and the area under the ROC curve was used to test the prediction eff ect of the model.Results There were 61 cases(64.21%)in the cured group and 34 cases(35.79%)in the non-cured group.Multivariate analysis results showed that the gender(OR=278.745,95%CI:6.540~11880.659,P=0.003),waist circumference(OR=1.261,95%CI:1.060~1.502,P=0.009),cardiovascular and cerebrovascular diseases(OR=222.908,95%CI:3.650~13614.182,P=0.010),and the number of preoperative hypertensive drugs(OR=1.310,95%CI:1.097~1.564,P=0.037)in the two groups were independent infl uencing factors for uncured postoperative hypertension in PA patients.On this basis,a nomogram risk prediction model was established.The area under the ROC curve was 0.968(95%CI:0.937~1.000,P<0.001),the sensitivity was 0.882,the specifi city was 0.984,and the Youden index was 0.866.Conclusion The patients'gender,waist circumference,cardiovascular and cerebrovascular diseases,and the number of preoperative hypertensive drugs were the independent infl uencing factors of uncured hypertension in PA patients undergoing SAAE.This model can eff ectively predict the postoperative hypertension status of PA patients,and provide a reference basis for early screening for high-risk patients with uncured hypertension after PA for medical staff.

关 键 词：原发性醛固酮增多症 经皮超选择性肾上腺动脉栓塞术 高血压 Logistic回归分析 列线图 风险预测模型 

分 类 号：R47[医药卫生—护理学]