基于心电心音图—血液指标的列线图对化疗后心脏不良事件风险的预测研究  

Prediction of Risk of Cardiac Adverse Events After Chemotherapy Based on Acoustic Cardiography-Blood Index Nomogram

作　　者：刘妍 李袁飞[2] 张文平[1] 贾瑞 平梅 LIU Yan;LI Yuanfei;ZHANG Wenping;JIA Rui;PING Mei(School of Public Health,Shanxi Medical University,Taiyuan 030001,China;Department of Oncology,The First Hospital of Shanxi Medical University,Taiyuan 030001,China;The First Clinical Medical School 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030001 [2]山西医科大学第一医院肿瘤科,太原030001 [3]山西医科大学第一临床医学院,太原030001

出　　处：《肿瘤防治研究》2024年第6期462-468,共7页Cancer Research on Prevention and Treatment

基　　金：山西省回国留学人员科研资助项目(2020-171);山西省留学回国人员科技活动择优资助项目(1176)。

摘　　要：目的探讨心电心音图联合血液指标预测恶性肿瘤患者化疗后发生心脏不良事件的风险。方法前瞻性收集171例恶性肿瘤患者。根据患者化疗结束后是否出现心脏不良事件分为心脏不良事件组和无心脏不良事件组,分析两组患者一般资料、化疗前血液指标与化疗早期(1~3周期)心电心音图相关指标,将可能影响因素进行二元Logistic回归分析确定独立预测因素并绘制列线图,利用受试者操作特征(ROC)曲线评估列线图预测能力。结果171例患者化疗结束后有44例发生心脏不良事件,发生率25.73%。二元logistic回归结果表示年龄、化疗前红细胞分布宽度(RDW)、活化部分凝血酶原时间(APTT)和化疗早期心脏电−机械激动时间(EMAT)是化疗患者发生心脏不良事件的独立预测因子,基于此绘制列线图,ROC曲线评估AUC为0.768(95%CI:0.693~0.843,P<0.001)。结论基于年龄、化疗前RDW、APTT和化疗早期EMAT绘制的列线图有助于早期评估化疗患者发生心脏不良事件的风险。Objective To evaluate the risk of cardiac adverse events in patients with malignant tumors after chemotherapy by using a combination of acoustic cardiography and blood indices.Methods A total of 171 patients with malignant tumor who received chemotherapy were included.They were divided into cardiac adverse event group and non-cardiac adverse event group in accordance with whether cardiac adverse events occurred after chemotherapy.The general data,blood indices before chemotherapy,and acoustic cardiography-related indices in the early stage(1-3 cycles)of chemotherapy of the two groups were analyzed.The possible influencing factors were determined by binary logistic regression analysis,and the nomogram was drawn.The receiver operating characteristic(ROC)curve was used to evaluate the prediction ability of the nomogram.Results Cardiac adverse events occurred in 44 of 171 patients with malignant tumors after chemotherapy,and the incidence of cardiac adverse events was 25.73%.Binary logistic regression results showed that age,red blood cell distribution width(RDW)before chemotherapy,activated partial thromboplastin time(APTT),and electromechanical activation time(EMAT)at the early stage of chemotherapy were independent predictors of cardiac adverse events in chemotherapy patients.The area under the ROC curve of the nomogram was 0.768(95%CI:0.693-0.843,P<0.001).Conclusion A nomogram based on age,pre-chemotherapy RDW,APTT,and EMAT at the early stage of chemotherapy is useful for early assessment of the risk of cardiac adverse events in chemotherapy patients.

关 键 词：心电心音图 血液指标 恶性肿瘤 心脏不良事件 列线图 

分 类 号：R730.7[医药卫生—肿瘤]