常规心电图在肺血管狭窄相关肺高血压中的预测价值  

The predictive value of routine electrocardiogram in pulmonary hypertension associated with pulmonary stenosis

作　　者：孙亚辉 米瑶 金俊灏 王海霞 苏红玲 曹云山 SUN Ya-hui;MI Yao;JIN Jun-hao;WANG Hai-xia;SU Hong-ling;CAO Yun-shan(The First Clinical Medical School,Lanzhou University,Lanzhou 730000,China;Department of Cardiology,Pulmonary Vascular Disease Center(PVDC),Gansu Provincial Hospital,Lanzhou 730000,China;Heart,Lung and Vessels Center,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital(The Affiliated Hospital of University of Electronic Science and Technology of China,Chengdu 610072,China))

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]甘肃省人民医院心内科肺血管病中心,甘肃兰州730000 [3]四川省医学科学院·四川省人民医院(电子科技大学附属医院)心肺血管中心,四川成都610072

出　　处：《实用医院临床杂志》2024年第5期28-34,共7页Practical Journal of Clinical Medicine

基　　金：国家自然科学基金资助项目(编号:82070052)。

摘　　要：目的探讨常规心电图在肺血管狭窄相关肺高血压的预测价值,并构建早期列线图预测模型。方法选取2018年1月至2021年10月就诊于甘肃省人民医院且确诊肺高血压患者231例,根据是否存在肺血管狭窄,分为肺血管狭窄组和非狭窄组,对比两组患者一般临床资料、超声心动图指标、血流动力学数据和常规心电图特征。采用单因素和多因素Logistics回归分析筛选肺血管狭窄的独立预测因素,基于肺血管狭窄独立预测因素构建列线图预测模型,并采用Bootstrap法进行内部验证。结果肺高血压患者共231例,其中肺血管狭窄组129例,年龄62.0(54.5,68.0)岁,男47例(36.4%),女82例(63.6%)。多因素Logistics回归分析结果显示,年龄(OR=1.136,95%CI:1.073~1.202),胸腔积液(OR=12.075,95%CI:2.254~64.678)、V_(1)导联S波幅度(OR=1.172,95%CI:1.009~1.362)均为肺血管狭窄的独立预测因素(P<0.05);基于独立预测因素构建列线图模型,列线图模型的受试者工作特征曲线的曲线下面积为0.853,列线图校准曲线接近于理想的对角线。结论根据年龄、胸腔积液、V_(1)导联S波幅度建立的列线图模型为预测肺高血压患者有无肺血管狭窄提供了一定的参考价值,有助于临床医生对肺血管狭窄进行早期筛查。Objective To investigate the predictive value of routine electrocardiogram(ECG)in pulmonary hypertension associated with pulmonary vascular stenosis and to construct an early nomogram prediction model.Methods Two hundred and thirty-one patients with confirmed pulmonary hypertension admitted to our hospital from January 2018 to October 2021 were selected.The patients were divided into a pulmonary vascular stenosis group and a non-stenosis group according to whether there was pulmonary vascular stenosis.General clinical data,echocardiographic data,hemodynamic data,and routine electrocardiogram characteristics of the two groups were compared.Logistic univariate and multivariate regression analyses were used to screen independent predictive factors of pulmonary vascular stenosis.A nomogram prediction model was constructed based on the independent predictive factors of pulmonary vascular stenosis.Bootstrap method was used for internal verification.Results There were 129 patients with pulmonary vascular stenosis in the 231 patients with pulmonary hypertension.The average age of the patients was 62.0(54.5,68.0)years old and 47 patients were males(36.4%)and 82 were females(63.6%).Logistic multivariate regression analysis revealed that age(OR=1.136,95%CI:1.073~1.202),pleural effusion(OR=12.075,95%CI:2.254~64.678)and V_(1) lead S-wave amplitude(OR=1.172,95%CI:1.009~1.362)were independent predictive factors for pulmonary vascular stenosis(P<0.05).Based on these independent predictive factors,a nomogram model was constructed.The area under the receiver operating characteristic curve(ROC)of the nomogram model was 0.853.The calibration curve was close to the ideal diagonal.Conclusions The nomogram model established based on age,pleural effusion,and V_(1) lead S-wave amplitude provides a certain reference value for predicting whether patients with pulmonary hypertension have pulmonary vascular stenosis.It helps clinicians perform early screening for pulmonary vascular stenosis.

关 键 词：肺高血压 肺血管狭窄 常规心电图 胸腔积液 列线图 

分 类 号：R543.2[医药卫生—心血管疾病] R540.4+1[医药卫生—内科学]