血清核因子-κB、肿瘤坏死因子-α、单核细胞趋化因子-1与老年冠状动脉粥样硬化性心脏病合并衰弱综合征的关系及预测模型构建  

Relationship between serum NF-κB,TNF-α,MCP-1 and senile coronary heart disease complicated with frailty syndrome and construction of prediction model of related factors

作　　者：袁点 李为真[1] 王蓉[2] 吴义林 陈洁[1] Yuan Dian;Li Weizhen;Wang Rong;Wu Yilin;Chen Jie(Shanghai First People’s Hospital Jiading Branch,Shanghai 201803,China;Shanghai Ruijin Hospital Wuxi Branch,WuxiJiangsu 214111,China)

机构地区：[1]上海市第一人民医院嘉定分院,上海嘉定201803 [2]上海交通大学医学院附属瑞金医院无锡分院,江苏无锡214111

出　　处：《中国医刊》2024年第8期856-860,共5页Chinese Journal of Medicine

基　　金：国家重点研发计划(SQ2018YFC200194-02);上海市嘉定区卫生健康委员会科研课题(SH20221517)。

摘　　要：目的分析血清核因子-κB(NF-κB)、肿瘤坏死因子-α(TNF-α)、单核细胞趋化因子-1(MCP-1)与老年冠状动脉粥样硬化性心脏病(CHD)合并衰弱综合征的关系并构建列线图预测模型。方法回顾性分析上海市第一人民医院嘉定分院2021年3月至2023年3月收治的50例老年CHD合并衰弱综合征患者的病例资料,将其设为观察组,采用埃德蒙顿衰弱等级量表(EFS)进行衰弱程度评估,分为轻度、中度、重度三组。另选取同期上海市第一人民医院嘉定分院收治的50例单纯老年CHD患者设为对照组,以及同期进行健康体检的50例老年人设为健康组。比较三组血清NF-κB、TNF-α、MCP-1水平及EFS评分,以及不同衰弱程度组血清NF-κB、TNF-α、MCP-1水平,Pearson法分析血清NF-κB、TNF-α、MCP-1与EFS评分的相关性。采用单因素及多因素logistic回归分析老年CHD合并衰弱综合征的危险因素,通过R软件构建列线图预测模型,以Bootstrap法进行内部验证,Hosmer-Lemeshow拟合优度检验,受试者工作特征曲线(ROC)对预测模型进行评价。结果观察组患者血清NF-κB、TNF-α、MCP-1水平及EFS评分均高于对照组和健康组(P<0.05)。重度组患者血清NF-κB、TNF-α、MCP-1水平均高于中度组、轻度组(P<0.05)。血清NF-κB、TNF-α、MCP-1水平与EFS评分均呈正相关关系(r=0.409、0.392、0.411,P<0.05)。多因素Logistic回归分析显示,年龄、抑郁症状、焦虑症状、营养不良、NYHA分级、身体活动量是老年CHD合并衰弱综合征的危险因素(P<0.05)。据此建立的列线图模型预测老年CHD合并衰弱综合征的区分能力较好(C-index=0.912),Hosmer-Lemeshow检验显示其拟合优度良好(χ^(2)=3.068,P=0.412);该预测模型预测老年CHD合并衰弱综合征的曲线下面积为0.915(95%CI 0.823~0.956)。结论老年CHD合并衰弱综合征患者血清NF-κB、TNF-α、MCP-1水平明显增高,且与衰弱严重程度密切相关,三者联合检测可提高对衰弱综�Objective To analyze the relationship between serum nuclear factor-κB(NF-κB),tumor necrosis factor-α(TNF-α),monocyte chemokine-1(MCP-1)and senile coronary heart disease(CHD)complicated with frailty syndrome,and to construct the prediction model of related factors.Method Fifty cases of elderly patients with CHD complicated with asthenic syndrome received in Shanghai First People’s Hospital Jiading Branch from March 2021 to March 2023 were selected as the observation group for retrospective study,another 50 cases of pure elderly patients with CHD received in Shanghai First People’s Hospital Jiading Branch during the same period were selected as the control group,and 50 cases of healthy elderly patients receiving physical examination in Shanghai First People’s Hospital Jiading Branch during the same period were selected as the healthy group.Serum NF-κB,TNF-αand MCP-1 were detected in all patients,and the level of NF-κB,TNF-αand MCP-1 and EFS scores were evaluated by Edmonton Frailty Scale(EFS).The levels of NF-κB,TNF-αand MCP-1 in the three groups were compared,and the levels of NF-κB,TNF-αand McP-1 in the groups with different frailty levels were compared.The correlation between serum NF-κB,TNF-αand MCP-1 and EFS scores was analyzed by Pearson,and the receiver operating curve(ROC)was plotted,and the area under the curve(AUC)was calculated,and the diagnostic efficacy of serum NF-κB,TNF-αand MCP-1 on asthenic syndrome was analyzed.The personal information of patients was collected by consulting medical records and consulting patients.The risk factors of elderly CHD complicated with asthenic syndrome were analyzed by univariate and multivariate logistic regression.A line graph prediction model was constructed by R software,and internal verifi cation was conducted by Bootstrap method.Hosmer-Lemeshow was used for goodness of fi t test.Result The levels of NF-κB,TNF-α,MCP-1 and EFS scores in observation group were higher than those in control group and healthy group(P<0.05).The levels of NF-κB,TN

关 键 词：核因子-ΚB 肿瘤坏死因子-Α 单核细胞趋化因子-1 冠状动脉粥样硬化性心脏病 衰弱综合征 危险因素 预测模型 

分 类 号：R541.4[医药卫生—心血管疾病]