209例老年慢性心力衰竭患者远期预后的影响因素Logistic回归分析  

Logistic regression analysis of influencing factors for long-term prognosis in 209 elderly patients with chronic heart failure

作　　者：张海红 朱秀鸣 汪海娅 Zhang Haihong;Zhu Xiuming;Wang Haiya(Department of Geriatric Medicine,Geriatrics Hospital,Pudong New District,Shanghai,201314,P.R.China;Department of Geriatric Medicine,Ninth People s Hospital Affiliated to Medical College of Shanghai Jiaotong University,Shanghai,200011,P.R.China)

机构地区：[1]上海市浦东新区老年医院老年科,上海201314 [2]上海交通大学医学院附属第九人民医院老年科,上海200011

出　　处：《老年医学与保健》2024年第5期1296-1302,共7页Geriatrics & Health Care

基　　金：浦东新区卫生健康委员会临床特色学科建设项目(PWYts2021-12)。

摘　　要：目的209例老年慢性心力衰竭患者远期预后的影响因素Logistic回归分析。方法对2017年1月—2018年12月上海市浦东新区老年医院209例老年慢性心力衰竭患者作为研究对象进行研究,回顾性收集患者临床资料。比较所有患者临床资料、远期预后情况,采用Logistic回归分析法分析老年慢性心力衰竭患者远期预后不良的影响因素,建立预测模型,并绘制受试者工作特征(ROC)曲线分析预测模型对老年慢性心力衰竭患者远期预后不良的预测价值。结果209例老年慢性心力衰竭患者,随访5年期间,70例患者死亡,发生率为33.49%(70/209)。较预后良好组,预后不良组美国纽约心脏病协会(NYHA)心功能分级为Ⅳ级的患者占比、血清肌肉生长抑制素(MSTN)、肌肉环指蛋白-1(MuRF-1)、N-末端B型利钠肽原(NT-proBNP)、直接胆红素(DBIL)、间接胆红素(IBIL)、总胆红素(TBIL)水平均更高;左室射血分数(LVEF)则更低(P<0.05)。Logistic回归分析结果显示,NYHA心功能分级为Ⅳ级、血清MSTN、MuRF-1、NT-proBNP、DBIL、IBIL、TBIL水平异常偏高均为老年慢性心力衰竭患者远期预后不良的影响因素,差异有统计学意义(OR=1.579,1.505,1.480,1.531,1.439,1.374,1.401,P<0.05)。将上述因素纳入预测模型:Logit(P)=-8.122+NYHA心功能分级×0.457+血清MSTN水平×0.409+血清MuRF-1水平×0.392+血清NT-proBNP水平×0.426+血清DBIL水平×0.364+血清IBIL水平×0.318+血清TBIL水平×0.337+LVEF×0.226。按照预测模型绘制预测老年慢性心力衰竭患者远期预后不良发生的ROC曲线,结果显示,当Logit(P)>7.635时,曲线下面积(AUC)为0.858,95%CI为0.8030.902,χ^(2)为13.381,诊断敏感度为77.14%、特异度为79.14%。结论老年慢性心力衰竭患者远期预后不良的影响因素主要为NYHA心功能分级为Ⅳ级、血清MSTN、MuRF-1、NT-proBNP、DBIL、IBIL、TBIL水平异常偏高,在影响因素基础上构建的预测模型具有良好的预测价值,临床可据此对Objective To analyze the influencing factors for the long-term prognosis of 209 elderly patients with chronic heart failure by logistic regression.Methods 209 elderly patients with chronic heart failure treated in Geriatrics Hospital in Pudong New District from January 2017 to December 2018 were selected as the study subjects,and their clinical data were collected retrospectively.The clinical data and long-term prognosis of all patients were compared.Logistic regression analysis was used to analyze the influencing factors for poor long-term prognosis in elderly patients with chronic heart failure,and then a prediction model was established.The receiver operating characteristic(ROC)curve was drawn to analyze the value of the model in predicting poor long-term prognosis in elderly patients with chronic heart failure.Results During 5-year follow-up,70 of 209 elderly patients with chronic heart failure died,with an incidence of 33.49%(70/209).Compared with the good prognosis group,the proportion of patients with New York Heart Association(NYHA)grade cardiac functionⅣ,and the levels of serum myostatin(MSTN),muscle ring finger protein-1(MuRF-1),N-terminal B-type natriuretic peptide(NT-proBNP),direct bilirubin(DBIL),indirect bilirubin(IBIL)and total bilirubin(TBIL)of the poor prognosis group were higher,but the left ventricular ejection fraction(LVEF)was lower(P<0.05).Logistic regression analysis showed that NYHA cardiac function gradeⅣand abnormally high levels of serum MSTN,MuRF-1,NT-proBNP,DBIL,IBIL and TBIL were all influential factors for poor long-term prognosis in elderly patients with chronic heart failure,and the difference was statistically significant(OR=1.579,1.505,1.480,1.531,1.439,1.374,1.401,P<0.05).The above factors were included in the prediction model:Logit(P)=-8.122+NYHA cardiac function grade×0.457+serum MSTN level×0.409+serum MuRF-1 level×0.392+serum NT-proBNP level×0.426+serum DBIL level×0.364+serum IBIL level×0.318+serum TBIL Level×0.337+LVEF×0.226.The ROC curve for predicting poor lon

关 键 词：老年 慢性心力衰竭 远期预后 影响因素 NYHA心功能分级 预测模型 LOGISTIC回归分析 

分 类 号：R541.6[医药卫生—心血管疾病]