多参数列线图预测代谢综合征病人并发冠心病的风险  

Multiparameter nomogram for predicting coronary heart disease in patients with metabolic syndrome

作　　者：王瑜 李伟 季春艳 银竟琨 吴强鹏 沐回凯 WANG Yu;LI Wei;JI Chunyan;YIN Jingkun;WU Qiangpeng;MU Huikai(Department of Ultrasound,Affiliated Hospital of Panzhihua University,Panzhihua,Sichuan 617000,China;Department of Endocrinology,Affiliated Hospital of Panzhihua University,Panzhihua,Sichuan 617000,China;Department of Cardiology,Affiliated Hospital of Panzhihua University,Panzhihua,Sichuan 617000,China)

机构地区：[1]攀枝花学院附属医院超声科,四川攀枝花617000 [2]攀枝花学院附属医院内分泌科,四川攀枝花617000 [3]攀枝花学院附属医院心内科,四川攀枝花617000

出　　处：《安徽医药》2024年第12期2492-2496,共5页Anhui Medical and Pharmaceutical Journal

基　　金：攀枝花学院医学类校级科学研究专项经费(PYYZ-2022-15)。

摘　　要：目的探讨代谢综合征病人心外膜脂肪组织(EAT)厚度与冠心病的关系,进一步建立和验证早期预测冠心病的列线图预测模型。方法回顾性纳入2020年3月至2023年1月攀枝花学院附属医院310例代谢综合征病人,使用随机数字表法按7∶3分配为训练集(n=217)和验证集(n=93)。根据病人冠状动脉造影检查结果,将训练集分为冠心病组(n=64)及非冠心病组(n=153)。在常规就诊记录中获取两组病人一般资料、生化检测指标及超声心动图参数。采用单因素分析及logistic回归分析筛选病人发生冠心病的危险因素,并构建列线图预测模型。通过C-index来评估该列线图的预测准确性和临床价值。结果单因素分析及logistic回归分析显示总胆固醇(TC)、C反应蛋白(CRP)、CRP/高密度脂蛋白胆固醇(HDL-C)、TC/HDL-C、EAT厚度与冠心病风险相关(P<0.05)。基于上述危险因素建立列线图预测模型,训练集中模型C-index为0.89[95%CI:(0.86,0.92)],验证集中C-index为0.73[95%CI:(0.69,0.77)]。结论该研究开发的列线图预测模型结合了代谢综合征病人血脂指标、炎症指标及超声心动图参数,可用于个体化预测冠心病发生风险,以便早期干预及治疗方案的调整。Objective To explore the relationship between epicardial adipose tissue(EAT)thickness and coronary heart disease in patients with metabolic syndrome,and establish and verify a nomogram prediction model for early prediction of coronary heart disease.Methods From March 2020 to January 2023,a total of 310 patients with metabolic syndrome in Affiliated Hospital of Panzhihua University were retrospectively enrolled and randomly assigned as training set(n=217)and testing set(n=93).Patients in the training set were divided into coronary heart disease group(n=64)and non-coronary heart disease group(n=153)according to the presence or absence of CH.The general data,biochemical indexes and echocardiographic parameters of the two groups of patients were obtained from patient records.The risk factors of coronary heart disease were screened by univariate analysis and logistic regression analysis,and a nomogram prediction model was constructed.The predictive accuracy and clinical value of the nomogram were evaluated by C-index.Results Univariate analysis and logistic regression showed that total cholesterol(TC),C-reactive protein(CRP),CRP/High density lipoprotein cholesterol(HDL-C),TC/HDL-C and EAT thickness are associated with coronary heart disease risk.A nomogram prediction model was established based on the above risk factors.The C-index of the model in the training set was 0.89[95%CI:(0.86,0.92)],and the C-index in the testing set was 0.73[95%CI:(0.69,0.77)].Conclusion The nomograms developed in the present study combines plasma lipid,inflammation and echocardiographic parameters in patients with metabolic syndrome,which can be used to individualize the risk of coronary heart disease for early prevention and treatment.

关 键 词：代谢综合征X 冠心病 心外膜脂肪组织 高密度脂蛋白胆固醇 C反应蛋白 列线图 

分 类 号：R541.4[医药卫生—心血管疾病] R589[医药卫生—内科学]