慢性阻塞性肺疾病合并慢性肺源性心脏病的影响因素分析及预测模型构建  

Analysis of influencing factors of chronic obstructive pulmonary disease complicated with chronic pulmonary heart disease and construction of a prediction model

作　　者：程亚楠 秦浩 李莉芳[2] 李峥岩 赵卉[2] Cheng Yanan;Qin Hao;Li Lifang;Li Zhengyan;Zhao Hui(The Second Clinical School of Medicine,Shanxi Medical University,Taiyuan 030000,China;Department of Respiratory and Critical Care Medicine,Second Hospital of Shanxi Medical University,Taiyuan 030000,China)

机构地区：[1]山西医科大学第二临床医学院,太原030000 [2]山西医科大学第二医院呼吸与危重症医学科,太原030000

出　　处：《国际呼吸杂志》2025年第2期119-128,共10页International Journal of Respiration

基　　金：山西省回国留学人员科研教研资助项目(2023-190);山西省科技合作交流专项项目(区域合作项目)(202204041101031)。

摘　　要：目的探讨慢性阻塞性肺疾病(慢阻肺病)合并慢性肺源性心脏病(CPHD)的影响因素,构建并验证预测模型。方法本研究为病例对照研究。采用非随机抽样的方法选取2022年1月至2024年3月于山西医科大学第二医院呼吸与危重症医学科住院治疗的407例慢阻肺病患者,利用R4.2.3软件,通过设置随机种子数,根据7∶3的比例随机分为训练集(286例)和验证集(121例)。根据是否合并CPHD将训练集慢阻肺病患者分为CPHD组(146例)和慢阻肺病组(140例)。收集所有患者的资料数据,包括人口学特征(性别、年龄、身体质量指数、吸烟指数),基础疾病(高血压、糖尿病),实验室检查[白细胞、红细胞、血小板、嗜酸性粒细胞(EOS)、中性粒细胞/淋巴细胞比值、纤维蛋白原、C反应蛋白、白蛋白、血尿素氮、脑利尿钠肽(BNP)、动脉血氧分压(PaO_(2))、氧合指数、动脉血二氧化碳分压(PaCO_(2))],肺功能检查[一秒率(FEV _(1)/FVC)、慢性阻塞性肺疾病全球创议(GOLD)分级]。比较训练集和验证集,慢阻肺病组和CPHD组患者的以上各项指标情况。单因素和多因素logistic回归分析影响慢阻肺病合并CPHD的危险因素,并绘制列线图。绘制受试者操作特征曲线评估模型的预测效果;采用Hosmer-Lemeshow检验评价模型的拟合优度,绘制校准曲线评价模型的校准性能;采用决策曲线分析评估模型的临床净效益。结果训练集中男252例,女34例;年龄(69±10)岁,年龄范围39~92岁;验证集中男105例,女16例;年龄(70±9)岁,年龄范围46~95岁。慢阻肺病组中男127例,女13例;年龄(68±9)岁,年龄范围39~90岁;CPHD组中男125例,女21例;年龄(71±9)岁,年龄范围43~92岁。训练集和验证集患者的各项临床资料比较差异无统计学意义(均P>0.05)。慢阻肺病组患者红细胞、中性粒细胞/淋巴细胞比值、血尿素氮、BNP水平低于CPHD组,血小板、EOS、白蛋白、FEV _(1)/FVC水平高于CPHD组,2组�ObjectiveTo identify the risk factors for chronic obstructive pulmonary disease(COPD)combined with chronic pulmonary heart disease(CPHD),and to construct a prediction model and validate it.MethodsThis was a cross-control study involving 407 COPD patients hospitalized in the Respiratory and Critical Care Medicine Department of Second Hospital of Shanxi Medical University between January 2022 and March 2024 via a non-random sampling.Using R4.2.3,a random seed number was created to allocate COPD patients into a training dataset(286 subjects)and a validation dataset(121 subjects)at a 7∶3 ratio.COPD patients in the training dataset were further categorized into COPD+CPHD cohort(146 subjects)and COPD-only group(140 subjects).Data were collected,including the demographic data(sex,age,body mass index[BMI],and smoking index),underlying diseases(hypertension,diabetes),laboratory testing(white blood cell[WBC],red blood cell[RBC],platelet[PLT],eosinophil[EOS],neutrophil-to-lymphocyte ratio[NLR],fibrinogen[Fib],C-reactive protein[CRP],albumin[ALB],blood urea nitrogen[BUN],brain natriuretic peptide[BNP],arterial partial pressure of oxygen[PaO_(2)],oxygenation index,and arterial partial pressure of carbon dioxide[PaCO_(2)]),and pulmonary function(forced expiratory volume in the first second to forced vital capacity ratio[FEV _(1)/FVC]and the Global Initiative for Chronic Obstructive Lung Disease[GOLD]classification).Differences in the above data were compared between the training and validation datasets,and between COPD+CPHD group and COPD-only group.Both univariate and multivariate logistic regression analyses were conducted to identify risk factors for COPD combined with CPHD,and a nomogram was plotted.The prediction value of the nomogram was validated by the receiver operating characteristic(ROC)curve.The Hosmer-Lemeshow test was used to test the goodness of fit,and the calibration curve was plotted to examine the calibration capabilities.Decision curve analysis(DCA)was deployed to assess the clinical net benefit.ResultsTh

关 键 词：肺疾病 慢性阻塞性 列线图 危险因素 利钠肽 脑 慢性肺源性心脏病 嗜酸性粒细胞 氧合指数 动脉血二氧化碳分压 

分 类 号：R54[医药卫生—心血管疾病]