慢性心力衰竭病人射血分数改善影响因素及列线图预测模型构建  

Influencing factors of ejection fraction improvement in patients with chronic heart failure and nomogram prediction model construction

作　　者：师彦虎 张帆[1] 孙敏[1] 王音[1] 任璐[2] SHI Yanhu;ZHANG Fan;SUN Min;WANG Yin;REN Lu(Department of Cardiology,Baoji Hospital of Traditional Chinese Medicine,Baoji,Shaanxi 721000,China;Department of Cardiology,Baoji Central Hospital,Baoji,Shaanxi 721000,China)

机构地区：[1]宝鸡市中医医院心内科,陕西宝鸡721000 [2]宝鸡市中心医院心内科,陕西宝鸡721000

出　　处：《安徽医药》2024年第5期929-934,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨慢性心力衰竭病人临床预后特征及射血分数(LVEF)改善影响因素并构建预测模型,为后续个体化治疗方案制定提供更多参考。方法研究纳入2016年1月至2018年3月于宝鸡市中医医院接受治疗慢性心力衰竭病人共132例,根据LVEF水平分为射血分数改善心力衰竭(HFrecEF)组(14例)、射血分数下降心力衰竭(HFrEF)组(37例)及射血分数正常心力衰竭(HFpEF)组(81例);比较各组临床特征资料及随访终点事件发生情况,采用多因素logistic回归模型评价慢性心力衰竭病人射血分数改善独立影响因素;基于上述独立影响因素构建列线图模型,描绘受试者操作特征(ROC)曲线评估模型预测慢性心力衰竭病人射血分数改善临床效能。结果HFrecEF组年龄显著低于HFrEF组及HFpEF组[(71.08±12.35)岁比(74.15±11.92)岁、(79.26±14.68)岁,P<0.05];HFrecEF组女性比例、扩张型心肌病比例、收缩压(SBP)、舒张压(DBP)及静息心率(HR)水平均显著高于其他两组(P<0.05);HFrecEF组左心室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)、左心房内径(LAD)及合并节段性室壁运动异常比例均显著低于HFrEF组(P<0.05);HFrecEF组LVEDD≤55 mm比例显著高于HFrEF组(P<0.05)。随访时HFrecEF组LVEF水平显著高于入院时(P<0.05);同时随访时HFrecEF组LVEDD、LVEDV及LAD均显著低于入院时(P<0.05);②HFrecEF组病死率和心血管相关病死率均显著低于其他两组(P<0.05);三组猝死率比较差异无统计学意义(P>0.05)。多因素分析结果显示,LVEDD≤55 mm、舒张压>85 mmHg、静息心率>90次/分及无陈旧性心肌梗死均是慢性心力衰竭病人射血分数改善独立影响因素(P<0.05)。根据慢性心力衰竭病人射血分数改善影响因素构建列线图模型,建模组和验证组预测慢性心力衰竭病人射血分数改善AUC分别为0.97[95%CI:(0.94,0.99)],0.94[95%CI:(0.91,0.98)];建模组列线图模型C-index为0.97,提示预测模型具有良好区分度�Objective To investigate the clinical prognosis characteristics of patients with chronic heart failure(CHF)and the factors influencing the improvement of ejection fraction(LVEF),and to construct the prediction model,so as to provide more reference for sub⁃sequent individualized treatment plan formulation.Methods One hundred and thirty-two patients with chronic heart failure treated in Baoji Hospital of Traditional Chinese Medicine from January 2016 to March 2018 were enrolled in this study.According to the level of LVEF,all patients were assigned into three groups:heart failure with improved ejection fraction(HFrecEF)group(14 cases),heart fail⁃ure with reduced ejection fraction(HFrEF)group(37 cases)and heart failure with normal ejection fraction(HFpEF)group(81 cases).The clinical characteristics and the incidence of follow-up end events were compared.Multivariate logistic regression model was used to evaluate the independent influencing factors for the improvement of ejection fraction in patients with chronic heart failure.The nomo⁃gram model was constructed based on the above independent influencing factors,and the ROC curve was delineated to evaluate the clinical efficacy of the model in predicting ejection fraction in patients with chronic heart failure.Results The age of HFrecEF group was significantly lower than that of HFrEF group and HFpEF group[(71.08±12.35)vs.(74.15±11.92),(79.26±14.68)year,P<0.05].The proportion of women,the proportion of dilated cardiomyopathy,the levels of systolic blood pressure(SBP),diastolic blood pressure(DBP)and resting heart rate(HR)of HFrecEF group were significantly higher than those in the other two groups(P<0.05).The propor⁃tions of left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic volume(LVEDV),left atrial diameter(LAD)and the proportion of segmental wall motion abnormalities of HFrecEF group were significantly lower than those in HFrEF group(P<0.05).The proportion of LVEDD≤55 mm of HFrecEF group was significantly higher than that in

关 键 词：心力衰竭 左心室射血分数 预后 超声心动图 

分 类 号：R541.6[医药卫生—心血管疾病]