基于左心室压力-应变环构建系统性红斑狼疮患者左心室心肌功能损害的列线图  

To Construct a Nomogram of Left Ventricular Myocardial Function Damage in Patients with Systemic Lupus Erythematosus Based on Left Ventricular Pressure-Strain Loop

作　　者：陈慧娟 陈丽丽 章春泉[2] Chen Huijuan;Chen Lili;Zhang Chunquan(Jiangxi Chest Hospital,Nanchang 330000,China;The Second Affiliated Hospital of Nanchang University,Nanchang 330008,China)

机构地区：[1]江西省胸科医院,南昌市330000 [2]南昌大学第二附属医院,南昌市330008

出　　处：《中国超声医学杂志》2024年第2期161-165,共5页Chinese Journal of Ultrasound in Medicine

基　　金：江西省卫生健康委科技计划项目(No.202211273)。

摘　　要：目的使用左心室压力-应变环心肌做功技术评估系统性红斑狼疮(SLE)患者心肌功能,并探讨基于左心室压力-应变环心肌做功技术参数构建SLE患者发生心肌功能损伤评估预测方法的应用价值。方法回顾性分析SLE患者135例,根据其是否出现左心室心肌功能损伤而将其分为损伤组及非损伤组,收集其治疗前后相关数据,对其进行危险因素分析并构建风险列线图模型,另收取收治的SLE患者58例,将其作为验证组。结果本研究中损伤组64例(47.41%),非损伤组71例(52.59%),多因素分析显示,两组的体质量指数(BMI)(OR=1.176,95%CI:1.007~1.372,P=0.041)、左心房前后径(LAD)(OR=1.220,95%CI:1.025~1.452,P=0.025)、左室射血分数(LVEF)(OR=0.907,95%CI:0.838~0.980,P=0.014)、整体有用功(GCW)(OR=0.998,95%CI:0.997~1.000,P=0.030)、整体无用功(GWW)(OR=1.014,95%CI:1.006~1.022,P<0.001)及整体做功效率(GWE)(OR=0.668,95%CI:0.555~0.805,P<0.001)等为SLE患者出现左心室心肌功能损伤的独立危险因素,以此建立风险列线图模型,Logit(p)=0.162×BMI+0.199×LAD-0.098×LVEF-0.002×GCW+0.014×GWW-0.403×GWE+34.533。其受试者工作特征(ROC)曲线下面积为0.901(95%CI:0.851~0.951),灵敏度为78.1%,特异度为88.7%,Youden指数为0.668(P<0.001),Hosemer-Lemeshow检验显示χ^(2)=4.410,P=0.818。结论本研究构建的以左心室压力-应变环心肌做功技术为基础的评估SLE患者心肌功能的风险列线图模型可为临床上提供一种用以识别SLE患者中的心肌损伤高风险患者的早期识别工具,也可从模型中相关因素出发调整医疗护理方案以降低患者发生心肌功能损伤的概率,具有较高的早期预警价值。Objective To evaluate myocardial function in patients with systemic lupus erythematosus(SLE)using left ventricular pressure-strain loop myocardial work technique,and to explore the application value of the methods for assessing myocardial function injury based on left ventricular pressure-strain loop myocardial work technique.Methods A retrospective analysis was performed on 135 patients with systemic lupus erythematosus admitted to Jiangxi Chest Hospital.Patients were divided into injured and non-injured groups based on their impairment of left ventricular myocardial function.Relevant data before and after treatment were collected.The risk factors for left ventricular myocardial function impairment were analyzed,and the risk nomogram models were constructed.In addition,58 patients with systemic lupus erythematosus admitted to Jiangxi Chest Hospital and the Second Affiliated Hospital of Nanchang University were collected as a verification group.Results In this study,64 cases(47.41%)were in the injured group and 71 cases(52.59%)were in the non-injured group.Multivariate analysis showed that the body mass index(BMI)(OR=1.176,95%CI:1.007-1.372,P=0.041),left atrial diameter(LAD)(OR=1.220,95%CI:1.025-1.452,P=0.025),left ventricle ejection fraction(LVEF)(OR=0.907,95%CI:0.838-0.980,P=0.014),global constructive work(GCW)(OR=0.998,95%CI:0.997-1.000,P=0.030),global waste work(GWW)(OR=1.014,95%CI:1.006-1.022,P<0.001)and global work efficiency(GWE)(OR=0.668,95%CI:0.555-0.805,P<0.001)were independent risk factors for left ventricular myocardial function injury in SLE patients.Based on this,a risk histogram model was established as follows:Logit(p)=0.162×BMI+0.199×LAD-0.098×LVEF-0.002×GCW+0.014×GWW-0.403×GWE+34.533.The area under ROC curve was 0.901,95%CI:0.851-0.951,sensitivity was 78.1%,specificity was 88.7%,Youden index was 0.668,P<0.001,Hosemer-Lemeshow test showedχ^(2)=4.410,P=0.818.Conclusions The risk nomogram model for evaluating myocardial function in patients with SLE based on left ventricular pressure-strain

关 键 词：左心室压力-应变环 系统性红斑狼疮 心肌功能损害 早期识别 列线图 

分 类 号：R445.1[医药卫生—影像医学与核医学] R593.241[医药卫生—诊断学]