类风湿关节炎合并心血管病高危风险患者预后不良的影响因素的预测模型

Predictive model of factors affecting the poor prognosis of patients with rheumatoid arthritis and high risk of cardiovascular disease

目的探讨类风湿关节炎(RA)合并心血管病高危风险患者预后不良的影响因素,构建并验证风险预测模型。方法回顾性分析2021年1月至2023年1月于河北医科大学第二医院接受治疗的195例RA合并心血管病高危风险患者的病历资料。依据80/20定律随机分为训练集(156例)和验证集(39例)。根据RA患者心血管疾病预后结局分为预后良好组和预后不良组,筛查RA患者发生心血管疾病的影响因素,构建并验证RA患者发生心血管疾病的风险预测模型。结果156例RA合并心血管病高危风险患者中,发生心血管疾病44例,发生率为21.21%(44例/156例)。预后不良组胰岛素抵抗占比、血脂异常占比、C反应蛋白(CRP)、红细胞沉降率(ESR)、颈动脉内膜-中层厚度(CIMT)高于预后良好组,托珠单抗使用占比低于预后良好组(P<0.05)。胰岛素抵抗(OR=4.043,95%CI:1.243~13.151)、血脂异常(OR=3.329,95%CI:1.398~7.934)、CRP(OR=3.059,95%CI:1.284~7.288)、ESR(OR=3.340,95%CI:1.402~7.959)、CIMT(OR=3.819,95%CI:1.603~9.099)是RA合并心血管病高危风险患者发生心血管疾病的危险因素(P<0.05),使用托珠单抗(OR=0.281,95%CI:0.118~0.668)是RA合并心血管病高危风险患者发生心血管疾病的保护因素(P<0.05)。列线图模型预测训练集RA合并心血管病高危风险患者发生心血管疾病的灵敏度为0.799(95%CI:0.726~0.921),特异度为0.895(95%CI:0.803~0.972),曲线下面积为0.906(95%CI:0.813~0.991)。列线图模型预测验证集RA合并心血管病高危风险患者发生心血管疾病的灵敏度为0.781(95%CI:0.725~0.919),特异度为0.863(95%CI:0.784~0.935),曲线下面积为0.885(95%CI:0.816~0.947)。结论胰岛素抵抗、血脂异常、CRP、ESR、CIMT、使用托珠单抗与RA合并心血管病高危风险患者发生心血管疾病有关,构建风险预测模型有助于早期筛查RA心血管疾病风险。

Objective To explore the factors that affect the poor prognosis of patients with rheumatoid arthritis(RA) who are at high risk of cardiovascular disease and construct and validate a risk prediction model.Methods A retrospective analysis was conducted on the medical records of 195 RA patients with high cardiovascular risk who were treated in Our Hospital from January 2021 to January 2023.They were randomly divided into a training set(n=156) and an independent validation set(n=39) based on the 80/20 rule.According to the outcomes of cardiovascular disease prognosis in RA patients, they were divided into a good prognosis group and a poor prognosis group, and the influencing factors of cardiovascular disease in RA patients were screened to construct and validate a risk prediction model for cardiovascular disease in RA patients.Results Among 156 patients with RA and high risk of cardiovascular disease, 44 cases developed cardiovascular disease, with a rate of 21.21%(44/156).The proportion of patients with poor prognosis, insulin resistance, dyslipidemia, C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),and carotid intima-media thickness(CIMT) were higher in the unfavorable prognosis group than in the favorable prognosis group.The proportion of tocilizumab use was lower in the unfavorable prognosis group than in the favorable prognosis group(P<0.05).Insulin resistance(OR=4.043,95% CI:1.243~13.151),dyslipidemia(OR=3.329,95% CI:1.398~7.934),CRP(OR=3.059,95% CI:1.284~7.288),ESR(OR=3.340,95% CI:1.402~7.959),and CIMT(OR=3.819,95% CI:1.603~9.099) were identified as risk factors for cardiovascular disease in patients with RA and high risk of cardiovascular disease(P<0.05).Tocilizumab use(OR=0.281,95% CI:0.118~0.668) was identified as a protective factor for cardiovascular disease in patients with RA and high risk of cardiovascular disease(P<0.05).The sensitivity of the line chart model for predicting the risk of cardiovascular disease in high-risk RA patients on the training set is 0.799(95% CI:0.726~0.921),with a specificity of 0.895(95% CI:0.803~0.972) and a area under the curve of 0.906(95% CI:0.813~0.991).The sensitivity of the line chart model for predicting the risk of cardiovascular disease in high-risk RA patients on the validation set is 0.781(95% CI:0.725~0.919),with a specificity of 0.863(95% CI:0.784~0.935) and an area under the curve of 0.885(95% CI:0.816~0.947).Conclusion Insulin resistance, lipid abnormalities, CRP,ESR,CIMT,and the use of tocilizumab are associated with high risk of cardiovascular disease in patients with RA who are at high risk for cardiovascular disease.Building a risk prediction model can help early screening for cardiovascular disease risk in RA.