糖尿病对老年射血分数保留心力衰竭患者预后的影响及预后预测模型构建  

Influence of diabetes mellitus on prognosis of elderly patients with heart failure with preserved ejection fraction and construction of prognosis prediction model

作　　者：储午阳 彭杰成 邵平 柳成将 曹余 CHU Wuyang;PENG Jiecheng;SHAO Ping;LIU Chengjiang;CAO Yu(Department of General Medicine,Anqing First People's Hospital of Anhui Medical University,Anqing,Anhui 246000,China;不详)

机构地区：[1]安徽医科大学附属安庆第一人民医院全科,安徽安庆246000 [2]安徽医科大学附属安庆第一人民医院心血管内科,安徽安庆246000

出　　处：《中国临床研究》2025年第4期554-557,562,共5页Chinese Journal of Clinical Research

基　　金：安徽省卫生健康委科研项目(AHWJ2021b103)。

摘　　要：目的 探讨糖尿病对老年射血分数保留心力衰竭(HFpEF)患者预后的影响,并构建预测老年HFpEF患者预后的列线图模型。方法 回顾性选取2020年1月至2023年1月安庆市第一人民医院收治的115例老年HFpEF患者,根据患者1年内是否出现主要心血管不良事件(MACE)分为预后不良组(40例)和预后良好组(75例)。收集患者的临床资料,采用logistic回归分析老年HFpEF患者发生MACE的影响因素,并构建列线图预测模型。结果 Logistic回归分析结果显示,合并糖尿病、纽约心脏病协会(NYHA)分级Ⅲ~Ⅳ级、高N末端B型利钠肽前体(NT-proBNP)、低老年营养风险指数(GNRI)是老年HFpEF患者预后不良的危险因素(P<0.05)。Hosmer-Lemeshow拟合优度检验结果显示,预测模型具有较高的拟合优度(χ^(2)=6.694,P=0.570)和较好的预测效能(受试者工作特征曲线下面积为0.936, 95%CI:0.894~0.977,灵敏度为87.50%,特异度为85.33%)。结论 合并糖尿病、NYHA分级Ⅲ~Ⅳ级、高NT-proBNP、低GNRI是老年HFpEF患者患病1年内发生MACE的危险因素,且构建的列线图模型对老年HFpEF患者预后有一定的预测价值。Objective To explore the influence of diabetes on the prognosis of elderly patients with heart failure with preserved ejection fraction(HFpEF),and to construct a nomogram model to predict the prognosis of elderly patients with HFpEF.Methods A total of 115 elderly patients with HFpEF admitted to Anqing First People's Hospital from January 2020 to January 2023 were selected retrospectively and divided into poor prognosis group(40 cases)and good prognosis group(75 cases)according to whether the patients had major cardiovascular adverse events(MACE)within one year.The clinical data were collected.Logistic regression was used to analyze the influencing factors of MACE in elderly patients with HFpEF,and nomogram prediction model was constructed.Results Logistic regression analysis showed that diabetes mellitus,New York Heart Association(NYHA)grade II-IV,high N-terminal pro-brain natriuretic peptide(NT-proBNP)and low geriatric nutritional risk index(GNRI)were the risk factors of poor prognosis in elderly patients with HFpEF(P<0.05).Hosmer-Lemeshow goodness-of-fit test results showed that the model had a high goodness-of-fit(χ^(2)=6.694,P=0.570)and good predictive performance[an area under the receiver operating characteristic curve was 0.936(95%Cl:0.894 to 0.977),with a sensitivity of 87.50%and a specificity of 85.33%].D0I:10.13429/j.cnki.cjcr.2025.04.013 Conclusion Comorbid diabetes,NYHA grade II-IV,high NT-proBNP and low GNRI are the risk factors of MACE in elderly patients with HFpEF within one year,and the nomogram model has a certain predictive value for the prognosis of elderly patients with HFpEF.

关 键 词：射血分数保留心力衰竭 糖尿病 预后 主要心血管不良事件 预测模型 

分 类 号：R541.6[医药卫生—心血管疾病]