上海市静安区中老年高血压患者并发心血管疾病风险预测模型的构建及验证  

Establishment and validation of a risk prediction model for hypertension complicated with cardiovascular disease in middle-aged and elderly patients in Jing'an District,Shanghai

作　　者：罗元欣 李方 谭军 彭德荣 LUO Yuanxin;LI Fang;TAN Jun;PENG Derong(Community Health Service Center of Pengpu New Village Street,Jing'an District,Shanghai 200000,China)

机构地区：[1]上海市静安区彭浦新村街道社区卫生服务中心,上海200000

出　　处：《山东医药》2025年第1期76-80,共5页Shandong Medical Journal

基　　金：国家心血管病中心心血管病高危人群早期筛查与综合干预项目(V10.0_2019-05-30)。

摘　　要：目的建立上海市静安区中老年高血压患者并发心血管疾病(CVD)的风险预测模型,为本地区的社区卫生服务提供科学依据。方法选择上海市静安区高血压患者1127例,按照2∶1的比例分为建模组751例及验证组376例。通过问卷调查和实验室检测收集数据,问卷调查内容包括性别、年龄、身高、体质量、腰围、吸烟、饮酒、糖尿病患病情况、服药情况及家族病史等一般资料,实验室检测内容包括总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血尿酸、尿蛋白、肾功能等指标。随访5年,记录患者发生CVD或因CVD死亡的例数。采用Logistic回归分析高血压并发CVD的独立危险因素并绘制列线图模型,采用使用受试者工作特征(ROC)曲线下面积(AUC)、Hosmer-Lemeshow拟合优度检验、校准曲线和决策曲线(DCA)评估预测模型的区分度、拟合度、校准度及临床实用性。结果建模组与验证组一般资料及实验室指标比较差异均无统计学意义(P均>0.05)。建模组751例研究对象中,共有163例(21.65%)进展为CVD。Logistic回归分析结果显示,高龄、男性、未服用降压药、超重或肥胖、吸烟史、高TG血症、高TC血症、高尿酸血症、高血压家族史、尿蛋白阳性、血脂危险度中高危是中老年高血压患者并发CVD的独立危险因素。根据独立影响因素构建中老年高血压患者并发CVD的列线图预测模型,ROC曲线分析显示,建模组、验证组预测中老年高血压患者发生CVD的AUC分别为0.763、0.806;校准曲线显示,建模组及验证组的校准曲线与理想曲线均基本贴合;Hosmer-Lemeshow拟合优度检验结果显示,建模组及验证组列线图模型与理想模型差异无统计学意义(P均>0.05)。DCA曲线结果显示,列线图预测模型在建模组及验证组中均表现出较高的临床实用价值。结论高龄、男性、未服用降压药、超重或肥胖、吸烟史、Objective To establish a risk prediction model for cardiovascular disease(CVD)complication in middle-aged and elderly hypertensive patients in Jing´an District,Shanghai,and to provide a scientific basis for community health services in this area.Methods Totally 1,127 hypertensive patients in Jing´an District,Shanghai were selected and divided into the modelling group of 751 cases and the validation group of 376 cases according to the ratio of 2:1.Data were collected through questionnaires and laboratory tests;questionnaires included general information such as gender,age,height,body mass,waist circumference,smoking,alcohol consumption,diabetes mellitus prevalence,medication use,and family history,while laboratory tests included total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein(LDL)cholesterol,high-density lipoprotein(HDL)cholesterol,blood uric acid,urinary proteins,and renal function,and other indicators.The patients were followed up for 5 years and the number of cases of CVD or death due to CVD was recorded.Logistic regression was used to analyse the independent risk factors for hypertension complicated with CVD and to draw a nomogram model,and the differentiation,degree of fitting,calibration and clinical utility of the predictive model were assessed by using the area under the curve(AUC)of the receiver operating characteristic(ROC),the Hosmer-Lemeshow goodness-of-fit test,calibration curve and decision curve(DCA).Results No statistically significant differences were found in the general information or laboratory indicators between the modelling and validation groups(all P>0.05).A total of 163(21.65%)of 751 study subjects in the modelling group progressed to CVD.Logistic regression analysis showed that advanced age,male,not taking antihypertensive medication,overweight or obesity,history of smoking,hypertriglyceridemia,hypercholesterolemia,hyperuricaemia,family history of hypertension,positive urinary protein,and moderate to high risk of lipid risk were independent risk factors for CVD among m

关 键 词：高血压 心血管疾病 风险预测模型 列线图 上海市 静安区 

分 类 号：R181[医药卫生—流行病学]