心房颤动患者华法林抗凝治疗发生抗凝过度的Nomogram预测模型构建  

Construction of Nomogram prediction model for over-anticoagulation in patients with atrial fibrillation receiving warfarin anticoagulation therapy

作　　者：叶秀芝 梅小建 谢丽园 黄梅[1] Ye Xiuzhi;Mei Xiaojian;Xie Liyuan;Huang Mei(Lishui Central Hospital,Lishui 323000,China)

机构地区：[1]浙江省丽水市中心医院,323000

出　　处：《心脑血管病防治》2024年第12期33-37,共5页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的探讨心房颤动患者华法林抗凝治疗发生抗凝过度的影响因素,并基于Nomogram模型建立抗凝过度风险预测模型。方法回顾性选取2019年2月至2022年2月在丽水市中心医院就诊的心房颤动患者278例,根据华法林抗凝治疗是否发生抗凝过度分为抗凝过度组83例和非抗凝过度组195例。采用Logistic回归法分析心房颤动患者发生抗凝过度的影响因素,并建立Nomogram风险预测模型。采用ROC曲线和校准曲线评估预测模型的区分度和校准度。结果心房颤动患者华法林抗凝治疗期间发生抗凝过度的发生率为29.86%(83/278)。单因素分析结果显示,两组患者年龄(χ^(2)=4.544,P<0.05)、体质量指数(BMI)(χ^(2)=5.199,P<0.05)、联用非甾体抗炎药物(χ^(2)=25.134,P<0.05)、早期国际标准化比值(INR)(χ^(2)=38.421,P<0.05)、低蛋白血症(χ^(2)=5.348,P<0.05)差异有统计学意义。多因素Logistic回归分析结果显示,年龄≥60岁(OR=3.305,P<0.05)、BMI≥24 kg/m^(2)(OR=5.163,P<0.05)、联用非甾体抗炎药物(OR=6.643,P<0.05)、早期INR>1.67(OR=4.596,P<0.05)是发生抗凝过度的危险因素,无低蛋白血症(OR=0.179,P<0.05)是发生抗凝过度的保护因素。Nomogram模型验证ROC的AUC为0.825(95%CI=0.775~0.874),最佳临界值为0.601,敏感度为0.867,特异度为0.733,该模型校准曲线的理论值和实际值有较好的一致性(χ^(2)=7.995,P>0.05)。结论对于年龄≥60岁、BMI≥24 kg/m^(2)、联用非甾体抗炎药物、早期INR>1.67、合并低蛋白血症的心房颤动患者在华法林抗凝治疗期间应密切监测患者INR水平,减少和预防抗凝过度的发生。基于Nomogram模型建立抗凝过度风险预测模型可以更准确地识别出高风险患者,从而指导个体化的监测和管理策略。Objective To investigate the influencing factors for over-anticoagulation in patients with atrial fibrillation receiving warfarin anticoagulation therapy and establish a Nomogram-based risk prediction model for over-anticoagulation.Methods Data of 278 patients with atrial fibrillation treated at Lishui Central Hospital from February 2019 to February 2022 were retrospectively collected.Patients were divided into an over-anticoagulation group(n=83)and a non-over-anticoagulation group(n=195)based on whether over-anticoagulation occurred during warfarin anticoagulation treatment.Logistic regression analysis was performed to identify factors influencing over-anticoagulation,and a Nomogram risk prediction model was developed.The discrimination and calibration of the prediction model were evaluated using the ROC and calibration curves.Results The incidence of over-anticoagulation during warfarin anticoagulation treatment in patients with atrial fibrillation was 29.86%(83/278).Univariate analysis results indicated significant differences in age(χ^(2)=4.544,P<0.05),body mass index(BMI)(χ^(2)=5.199,P<0.05),concomitant use of nonsteroidal anti-inflammatory drugs(NSAIDs)(χ^(2)=25.134,P<0.05),early international normalized ratio(INR)(χ^(2)=38.421,P<0.05),and hypoalbuminemia(χ^(2)=5.348,P<0.05).Multivariate logistic regression analysis revealed that age≥60 years(OR=3.305,P<0.05),BMI≥24 kg/m^(2)(OR=5.163,P<0.05),concomitant use of NSAIDs(OR=6.643,P<0.05),and early INR>1.67(OR=4.596,P<0.05)were independent risk factors for over-anticoagulation,while lack of hypoalbuminemia(OR=0.179,P<0.05)was a protective factor.The ROC analysis of the Nomogram model showed an AUC of 0.825(95%CI=0.775-0.874),with an optimal cutoff value of 0.601,sensitivity of 0.867,and specificity of 0.733.The calibration curve demonstrated good consistency between theoretical and actual values(χ^(2)=7.995,P>0.05).Conclusion Patients with atrial fibrillation aged≥60 years,with BMI≥24 kg/m^(2),concomitant NSAIDs use,early INR>1.67,and hypoalbuminem

关 键 词：心房颤动 华法林 抗凝过度 Nomogram预测模型 

分 类 号：R54[医药卫生—心血管疾病]