体质量指数对前列腺癌合并心血管疾病的老年患者预后的影响及列线图构建  

Effect of body mass index on prognosis of elderly patients with prostate cancer and cardiovascular disease and construction of a nomogram

作　　者：白盼盼 李春霞 卜星彭 兰宁 陈还珍 Bai Panpan;Li Chunxia;Bu Xingpeng;Lan Ning;Chen Huanzhen(School of Public Health,Shanxi Medical University,Taiyuan 030012,China;Department of General Medicine,Shanxi Bethune Hospital,Taiyuan 030032,China;Department of Cardiology,First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学公共卫生学院,太原030012 [2]山西白求恩医院综合医疗科,太原030032 [3]山西医科大学第一医院心血管内科,太原030001

出　　处：《中华老年多器官疾病杂志》2024年第2期103-109,共7页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：2021年山西省基础研究计划(自由探索类)第二批项目(20210302123409)。

摘　　要：目的探讨体质量指数(BMI)对前列腺癌合并心血管疾病的老年患者预后的影响,构建并验证患者1年内心血管病再入院的预测列线图。方法回顾性分析2019年5月至2021年5月于山西医科大学第一医院初诊为前列腺癌伴心血管疾病的237例患者的临床资料。根据中国肥胖工作组(WGOC)推荐的BMI标准将患者分为高BMI组(110例)和低BMI组(127例),比较两组患者基线资料、实验室和影像学检查等临床资料。主要终点事件为1年内心血管病再入院,次要终点为1年内全因死亡。采用SPSS 26.0和R Studio(4.1.2版本)进行数据分析。根据数据类型,分别采用t检验、Mann-Whitney U检验或χ2检验进行组间比较。采用Kaplan-Meier法绘制生存曲线,通过多因素Cox回归模型分析患者预后的影响因素并建立患者预后预测列线图模型。结果118例患者CVD再入院,其中低BMI组71例(55.9%),高BMI组47例(42.7%);全因死亡4例,其中低BMI组3例(2.4%),高BMI组1例(0.9%)。Kaplan-Meier生存分析显示,低BMI组患者首次CVD再住院率高于高BMI组,尤其是冠心病,差异有统计学意义(P<0.05);而两组全因死亡事件情况比较,差异无统计学意义(P>0.05)。多因素Cox回归模型分析显示,吸烟(HR=3.954,95%CI 2.359~6.628;P<0.05)、高总胆固醇(HR=1.070,95%CI 1.035~1.107;P<0.05)和其他系统疾病(HR=1.611,95%CI 1.103~2.351;P<0.05)是心血管病再入院发生的独立危险因子;高BMI(HR=0.920,95%CI 0.862~0.981;P<0.05)和高水平高密度脂蛋白胆固醇(HR=0.460,95%CI 0.245~0.865;P<0.05)是心血管病再入院发生的独立保护因素。列线图内部验证C-index为0.731(95%CI 0.686~0.776)。受试者工作特征(ROC)曲线下面积(AUC)3个月为0.759(95%CI 0.689~0.829)、6个月为0.767(95%CI 0.699~0.834)、12个月为0.804(95%CI 0.696~0.912)。AUC均在0.671~0.804,提示模型具有中等预测价值,校准图呈现出较好的一致性。结论吸烟、总胆固醇、其他系统疾病、BMI和高密度脂蛋白胆�Objective To determine the effect of body mass index(BMI)on the prognosis of the elderly cardiovascular disease(CVD)patients with prostate cancer,and construct and validate a predictive nomogram for 1-year readmission of the patients due to CVD.Methods Clinical data of 237 elderly CVD patients with freshly diagnosed prostate cancer in the First Hospital of Shanxi Medical University from May 2019 to May 2021 were collected and retrospectively analyzed.According to the BMI criteria recommended by the Working Group on Obesity in China(WGOC),they were divided into high BMI group(n=110)and low BMI group(n=127).Their baseline data,laboratory results and imaging data were compared between the two groups.The primary endpoint was the first rehospitalization due to CVD and the secondary endpoint was all-cause death within one year after discharge.SPSS statistics 26.0 and R Studio(version 4.1.2)were used for data analysis.Student's t test,Mann-Whitney U test or Chi-square test was employed for intergroup comparison depending on data type.Kaplan-Meier survival curve was plotted to analyze their survival.Multivariate Cox regression analysis was performed to analyze the independent prognostic factors and a nomogram of prognostic prediction was constructed.Results A total of 118 patients were rehospitalized due to CVD,including 71 cases from the low BMI group(55.9%)and 47 cases from the high BMI group(42.7%).Among the four cases of all-cause death,three were in the low BMI group(2.4%)and one was in the high BMI group(0.9%).Kaplan-Meier survival curves revealed that the low BMI patients had higher rate of rehospitalization due to CVD than the high BMI patients,especially coronary heart disease(P<0.05).But there was no significant difference in all-cause mortality between the two groups(P>0.05).Multivariate Cox regression analysis showed that smoking(HR=3.954,95%CI 2.359-6.628;P<0.05),high total cholesterol(HR=1.070,95%CI 1.035-1.107;P<0.05)and comorbidities of other systems(HR=1.611,95%CI 1.103-2.351;P<0.05)were independent risk

关 键 词：前列腺癌 心血管疾病 预后 列线图 

分 类 号：R541.6[医药卫生—心血管疾病]