慢性心力衰竭患者并发高尿酸血症的影响因素分析及模型构建  

Analysis of Influencing Factors of Hyperuricemia in Chronic Heart Failure Patients and Model Construction

作　　者：王云香[1] 许孟 周玲[3] WANG Yunxiang;XU Meng;ZHOU Ling(Department of Neurology,Nanyang Central Hospital,Nanyang 473000,China;Department of CT Imaging,Nanyang Central Hospital,Nanyang 473000,China;Department of CT Imaging Diagnosis,Nanyang Central Hospital,Nanyang 473000,China)

机构地区：[1]南阳市中心医院神经内科,河南南阳473000 [2]南阳市中心医院CT影像科,河南南阳473000 [3]南阳市中心医院CT影像诊断科,河南南阳473000

出　　处：《河南医学研究》2024年第9期1613-1617,共5页Henan Medical Research

摘　　要：目的探讨慢性心力衰竭(CHF)患者并发高尿酸血症的影响因素,建立logistic回归模型并进行验证。方法回顾性选取2021年6月至2023年6月南阳市中心医院收治的100例CHF患者为研究对象,依据是否并发高尿酸血症分为合并组(42例)、未合并组(58例)。比较两组临床资料,并分析高尿酸血症发生的影响因素。依据影响因素分别建立2个logistic回归模型(模型1、模型2),评价模型区分度、拟合度及临床实用价值。结果心房颤动、高嘌呤饮食、单核细胞计数与高密度脂蛋白胆固醇比值(MHR)、低密度脂蛋白胆固醇(LDL-C)、基质金属蛋白酶-9(MMP-9)、丙二醛(MDA)为高尿酸血症发生的独立危险因素,超氧化物歧化酶(SOD)、经常锻炼为高尿酸血症发生的独立保护因素(P<0.05);将心房颤动、高嘌呤饮食、经常锻炼、MHR、LDL-C纳入模型1,将心房颤动、高嘌呤饮食、MHR、LDL-C、MMP-9、MDA、SOD、经常锻炼纳入模型2,模型1、模型2诊断高尿酸血症发生的曲线下面积(AUC)分别为0.793、0.908,模型2与观测值拟合度良好,当高风险阈值为0.02~0.73时模型2净获益率具有临床价值。结论心房颤动、高嘌呤饮食、MHR、LDL-C、MMP-9、MDA为CHF患者并发高尿酸血症的独立危险因素,SOD、经常锻炼为CHF患者并发高尿酸血症的独立保护因素,基于上述影响因素建立的回归模型对高尿酸血症的诊断效能更优,临床可依据上述模型筛选高危人群,并给予干预措施,以降低高尿酸血症发生风险。Objective To investigate the influencing factors of hyperuricemia in patients with chronic heart failure(CHF),and a establish logistic regression model.Methods A total of 100 CHF patients admitted to Nanyang central Hospital from June 2021 to June 2023 were retrospectively selected as the study objects,and were divided into the combined group(42 cases)and the non-combined group(58 cases)according to whether they were complicated with hyperuricemia.The clinical data of the two groups were compared,and the influencing factors of hyperuricemia were analyzed.Two logistic regression models(model 1 and model 2)were established according to the influencing factors,and the differentiation,fit and clinical practical value of the models were evaluated.Results Atrial fibrillation,high-purine diet,monocyte count,high-density lipoprotein cholesterol ratio(MHR),low-density lipoprotein cholesterol(LDL-C),matrix metalloproteinase-9(MMP-9)and malondialdehyde(MDA)were independent risk factors for the development of hyperuricemia,while superoxide dismutase(SOD)and regular exercise were independent protective factors for the development of hyperuricemia(P<0.05).Atrial fibrillation,high-purine diet,regular exercise,MHR and LDL-C were includeed in model 1,while atrial fibrillation,high-purine diet,MHR,LDL-C,MMP-9,MDA,SOD and regular exercise were includeed in model 2.The area under the curve(AUC)for the diagnosis of hyperuricemia in models 1 and 2 was 0.793 and 0.908,respectively.Model 2 had a good fit with observed values,and when the high-risk threshold was 0.02 to 0.73,the net benefit rate of model 2 had clinical value.Conclusion Atrial fibrillation,high-purine diet,MHR,LDL-C,MMP-9 and MDA are independent risk factors for CHF patients with hyperuricemia,while SOD and regular exercise are independent protective factors.The regression model established based on the above influencing factors has better diagnostic efficacy for hyperuricemia.Clinicians can screen high-risk populations based on the above model and provide intervention me

关 键 词：慢性心力衰竭 高尿酸血症 影响因素 诊断价值 

分 类 号：R541.4[医药卫生—心血管疾病]