基于脉图参数构建原发性高血压患者伴肾损害的风险预测列线图模型  

Risk Prediction Nomogram Model for Essential Hypertension Patients with Renal Damage Based on Pulse Diagram Parameters

作　　者：张梦楚 赵倩倩 解天骁 郭睿[1] 王忆勤[1] 燕海霞[1] ZHANG Mengchu;ZHAO Qianqian;XIE Tianxiao;GUO Rui;WANG Yiqin;YAN Haixia(Shanghai Key Laboratory of Health Identification and Assessment,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学上海市健康辨识与评估重点实验室,上海201203

出　　处：《世界科学技术-中医药现代化》2024年第9期2212-2218,共7页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：国家自然科学基金委员会面上项目(81973749):基于中医脉象检测的原发性高血压患者不同心血管危险分层预警模型的构建与验证,负责人:燕海霞;国家自然科学基金委员会面上项目(81473594):基于血液动力学原理和方法的中医脉象分析与血管功能状态评价研究,负责人:燕海霞。

摘　　要：目的构建基于脉图参数的原发性高血压患者伴肾损害的风险预测列线图模型。方法选择2018年8月-2021年6月在上海中医药大学附属曙光医院、上海市中西医结合医院心内科住院治疗的原发性高血压患者518例,根据原发性高血压合并肾损害评估标准分为高血压无肾损害组和高血压伴肾损害组。采集患者一般资料、血生化指标,应用SMART-I型中医脉象数字化分析仪检测脉图参数,比较2组上述指标的差异。采用单因素和多因素Logistic回归分析相关参数;应用R Studio构建原发性高血压患者伴肾损害的风险预测列线图模型,并对该模型进行评估。结果原发性高血压伴肾损害组的年龄、血清尿酸、血清肌酐、尿素氮、胱抑素C、同型半胱氨酸显著高于无肾损害组(P<0.05),目前舒张压显著低于无肾损害组(P<0.01)。原发性高血压伴肾损害组脉图参数H4、H3/H1、H4/H1、H5/H1、T1/T4、W1/T显著低于无肾损伤组(P<0.01),As/Ad显著高于无肾损伤组(P<0.01)。年龄、目前舒张压、H4/H1、T1/T4、W1/T是原发性高血压患者伴肾损害风险的独立危险因素。基于以上独立危险因素建立列线图模型,并对该模型进行检验,ROC曲线下面积为0.703(95%CI:0.625-0.781),校正曲线与理想曲线拟合较好,Hosmer-Lemeshow拟合优度检验表明该列线图模型具有较好的校准度。结论基于脉图参数构建的列线图模型能较准确地预测原发性高血压患者伴肾损害的发生风险,可为临床预测高血压伴发肾损害风险提供参考依据。Objective To construct a nomograph model for predicting the risk of renal damage in patients with essential hypertension based on pulse parameters.Methods 518 patients with essential hypertension who were hospitalized in Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine and Cardiology Department of Shanghai Integrated Hospital of Traditional Chinese and Western Medicine from August 2018 to June 2021 were selected,and were divided into hypertension without renal damage group and hypertension with renal damage group according to the evaluation criteria of essential hypertension with renal damage.The general data and blood biochemical indexes of the patients were collected,and the pulse parameters were detected by SMART-I digital pulse analyzer of traditional Chinese medicine,and the differences between the two groups were compared.Single factor and multi factor logistic regression were used to analyze the related parameters;The nomogram model was constructed by R Studio,and the model was evaluated by the ROC curve,calibration curve,and Hosmer Lemeshow goodness of fit test.Results The age,serum uric acid,serum creatinine,urea nitrogen,cystatin C and homocysteine in the group of primary hypertension with renal damage were significantly higher than those in the group without renal damage(P<0.05).The pulse parameters H4,H3/H1,H4/H1,H5/H1,T1/T4,W1/T in patients with primary hypertension and renal injury were significantly lower than those in patients without renal injury(P<0.01),and As/Ad was significantly higher than those in patients without renal injury(P<0.01).Age,current diastolic blood pressure,H4/H1,T1/T4,W1/T were independent risk factors of renal damage in patients with essential hypertension.The nomogram model was established based on the above independent risk factors,and the model was tested.The area under the ROC curve was 0.703(95%CI:0.625-0.781),and the calibration curve was well fitted with the ideal curve.The Hosmer Lemeshow goodness of fit test showed that the nomogram

关 键 词：高血压 肾损害 脉图参数 列线图模型 

分 类 号：R-058[医药卫生]