维持性血液透析患者并发主要不良心血管事件的影响因素分析  

Analysis of influencing factors of major adverse cardiovascular events in maintenance hemodialysis patients

作　　者：冯季[1] 孙亦兵[1] 刘淑婷 王一帆 赵东霞 黄晓梦 Feng Ji;Sun Yibing;Liu Shuting;Wang Yifan;Zhao Dongxia;Huang Xiaomeng(Department of Blood Purification,The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院血液净化科,张家口075000

出　　处：《中国医师杂志》2025年第1期52-56,61,共6页Journal of Chinese Physician

基　　金：河北省医学科学研究课题计划(20231438);张家口市市级科技计划(2221163D)。

摘　　要：目的探讨维持性血液透析(MHD)患者并发主要不良心血管事件(MACE)的影响因素,构建列线图并验证。方法回顾性分析2022年7月—2023年10月河北北方学院附属第一医院收治的240例MHD患者的临床资料,根据患者是否发生MACE分为两组,即发生组(发生MACE,n=55),未发生组(未发生MACE,n=185),比较两组临床资料后,再经二元logistic回归分析法筛选MHD患者并发MACE的独立危险因素,再依据危险因素构建风险列线图预测模型,以Bootstrap法分析该模型的预测效能。结果两组年龄、透析龄、高血脂、高尿酸血症、血液透析通量差异有统计学意义(均P<0.05)。二元logistic回归模型分析结果显示,透析龄>12个月、合并高血脂、合并高尿酸血症、低通量血液透析是MHD患者并发MACE的独立危险因素(均P<0.05)。基于独立危险因素构建列线图风险预测模型,预测模型曲线下面积(AUC)为0.842(95%CI:0.789~0.896),特异度为69.1%,灵敏度为89.7%,截断值为13.128,约登指数为0.588,提示本模型准确性较好。结论透析龄>12个月、合并高血脂、合并高尿酸血症、低通量血液透析是MHD患者并发MACE的独立危险因素,针对危险因子加以干预、控制,能够降低MACE的发生率。Objective To investigate the influencing factors of major adverse cardiovascular events(MACE)in maintenance hemodialysis(MHD)patients,and to construct and verify the nomogram.MethodsThe clinical data of 240 patients with MHD admitted to the First Affiliated Hospital of Hebei North University from July 2022 to October 2023 were retrospectively analyzed.According to whether the patients had MACE,they were divided into two groups,namely the occurrence group(with MACE,n=55)and the non-occurrence group(without MACE,n=185).After comparing the clinical data of the two groups,The independent risk factors of MHD patients with MACE were screened by binary logistic regression analysis,and the risk nomogram prediction model was constructed according to the risk factors,and the prediction efficiency of the model was analyzed by Bootstrap method.ResultsThere were significant differences in age,dialysis age,hyperlipidemia,hyperuricemia and hemodialysis flux between the two groups(all P<0.05).Binary logistic regression model analysis showed that dialysis age>12 months,combined with hyperlipidemia,combined with hyperuricemia,and low throughput hemodialysis were independent risk factors for MHD patients with MACE(all P<0.05).The neomorph risk prediction model was constructed based on independent risk factors.The area under the curve(AUC)of the prediction model was 0.842(95%CI:0.789-0.896),the specificity was 69.1%,the sensitivity was 89.7%,the cutoff value was 13.128,and the Yoden index was 0.588,suggesting that the accuracy of the model was good.ConclusionsDialysis age>12 months,combined with hyperlipidemia,combined with hyperuricemia and low throughput hemodialysis are independent risk factors for MACE in MHD patients.Intervention and control of risk factors can reduce the incidence of MACE.

关 键 词：血液透析 主要不良心血管事件 危险因素 

分 类 号：R692.5[医药卫生—泌尿科学]