高尿酸血症与慢性肺源性心脏病的相关性研究:基于LASSO回归与倾向性评分匹配法  

Correlation Study between Hyperuricemia and Chronic Pulmonary Heart Disease:Based on LASSO Regression and Propensity Score Matching

作　　者：祁海燕 王捷[2] 罗玉玺 武云[1] QI Haiyan;WANG Jie;LUO Yuxi;WU Yun(Department of General Practice,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China;Department of Clinical Medicine Discipline,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China;The First Clinical Medical of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学第一附属医院全科医学科,新疆维吾尔自治区乌鲁木齐市830011 [2]新疆医科大学第一附属医院临床药学科,新疆维吾尔自治区乌鲁木齐市830011 [3]新疆医科大学第一临床医学院,新疆维吾尔自治区乌鲁木齐市830011

出　　处：《中国全科医学》2024年第24期2954-2960,2968,共8页Chinese General Practice

基　　金：国家自然科学基金地区科学基金项目(82260081);“天山英才”培养计划(2022TSYCCX0034)。

摘　　要：背景近年来众多研究表明高尿酸血症(HUA)是某些疾病的影响因素,然而HUA是否为慢性肺源性心脏病(CPHD)的影响因素仍需进一步研究。目的探讨HUA与CPHD的相关性,旨在为CPHD患者血尿酸(SUA)水平的管理提供理论依据。方法纳入2019—2023年新疆医科大学第一附属医院收治的1171例慢性阻塞性肺疾病(COPD)患者为研究对象,根据其是否患有CPHD分为CPHD组(470例)和COPD组(701例)。收集患者一般资料和实验室检查及超声心动图检查结果。采用LASSO回归法对变量进行筛选,采用倾向性评分匹配法(PSM)排除混杂因素影响。采用多因素Logistic回归分析探究COPD患者合并CPHD的影响因素。结果CPHD组女性、汉族、吸烟、饮酒、特发性肺纤维化、慢性支气管炎、支气管哮喘比例、淋巴细胞百分比、左心室舒张末期内径、左心室收缩末期内径、心输出量、左心室射血分数低于COPD组,心功能3~4级、HUA、肺栓塞、先天性心脏病比例、红细胞计数、中性粒细胞百分比、SUA、血尿素氮、D-二聚体、N末端-B型利钠肽前体、右心房内径、右心室内径、左心房内径、右心室流出道内径、肺动脉内径高于COPD组,差异有统计学意义(P<0.05)。LASSO回归筛选出变量后进行PSM,最终得到COPD组469例、CPHD组469例。匹配后CPHD组心功能3~4级、HUA占比、右心房内径、右心室内径、右心室流出道内径、肺动脉内径大于COPD组,支气管哮喘、淋巴细胞百分比低于COPD组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,HUA升高、心功能3~4级、右心房内径、右心室内径、肺动脉内径增加是COPD患者合并CPHD的危险因素(P<0.05),患有支气管哮喘、左心室舒张末期内径增加为COPD患者合并CPHD的保护因素(P<0.05)。将SUA水平按四分位数分层,多因素Logistic回归分析结果显示,与Q1(SUA<237.31μmol/L)比较,Q4(SUA>381.29μmol/L)患者患有CPHD的风险增�Background In recent years,numerous studies have indicated that hyperuricemia(HUA)is a contributing factor to certain diseases.However,whether HUA is a contributing factor to chronic pulmonary heart disease(CPHD)still requires further investigation.Objective To explore the association between HUA and CPHD,aiming to provide a theoretical basis for the management of serum uric acid(SUA)levels in patients with CPHD.Methods A total of 1171 patients with chronic obstructive pulmonary disease(COPD)admitted to the First Affiliated Hospital of Xinjiang Medical University from 2019 to 2023 were included in the study.They were divided into a CPHD group(470 cases)and a COPD group(701 cases)based on whether they had CPHD.General information,laboratory test results,and echocardiographic findings of the patients were collected.LASSO regression was used to select variables,and propensity score matching(PSM)was employed to eliminate the influence of confounding factors.Multivariate Logistic regression analysis was conducted to explore the influencing factors of CPHD in COPD patients.Results The CPHD group had lower proportions of females,Han ethnicity,smokers,drinkers,idiopathic pulmonary fibrosis,chronic bronchitis,bronchial asthma,lymphocyte percentage,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,cardiac output,left ventricular ejection fraction compared to the COPD group.Higher proportions of heart function class 3-4,HUA,pulmonary embolism,congenital heart disease,red blood cell count,neutrophil percentage,SUA,blood urea nitrogen,D-dimer,N-terminal pro-B-type natriuretic peptide,right atrial diameter,right ventricular diameter,left atrial diameter,right ventricular outflow tract diameter,and pulmonary artery diameter were observed in the CPHD group,with statistically significant differences(P<0.05).After variable selection by LASSO regression and PSM,469 cases were included in both the COPD and CPHD groups.After matching,the CPHD group had higher proportions of heart function class 3-4,HUA,ri

关 键 词：肺心病 高尿酸血症 肺疾病 慢性阻塞性 病例对照研究 最小绝对收缩和选择算法 倾向性评分 

分 类 号：R541.5[医药卫生—心血管疾病]