个体化预测奥曲肽治疗上消化道出血患者发生心律失常的风险模型建立

Establishment of individual models for predicting the risk of arrhythmia in patients with upper gastrointestinal hemorrhage treated with octreotide

目的探讨奥曲肽引起上消化道出血患者心律失常的危险因素,并建立列线图模型。方法回顾性分析2017年1月-2019年12月于本院应用奥曲肽治疗的上消化道出血患者的临床资料,分别使用单因素和Logistic回归多因素分析发生心律失常的独立危险因素,并建立相关列线图预测模型。结果两组患者在性别、吸烟史、饮酒史、高脂血症方面无差异(P>0.05),两组患者在年龄、体质量指数(BMI)、高血压、糖尿病、冠心病、心率减慢史和血清钾方面的差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示BMI无明显差异(P>0.05),因此给予剔除,筛选出年龄、高血压、糖尿病、冠心病、心率减慢史和血清钾为奥曲肽治疗上消化道出血患者发生心律失常的独立危险因素(P<0.05)。基于以上6项独立危险因素建立列线图模型,并且对列线图模型进行验证,结果显示训练集和验证集的预测值与实测值基本一致,训练集C-index指数为0.844(95%CI:0.812~0.876),验证集的准确性也高达81.6%,说明该研究的列线图模型具有精准的预测能力。结论影响奥曲肽治疗上消化道出血患者心律失常的因素多种多样,临床上应针对高龄、高血压、糖尿病、冠心病、有心率减慢史和血清钾降低的患者加强防范。

Objective To determine the risk factors of arrhythmia caused by octreotide in patients with upper gastrointestinal bleeding,and to establish a nomogram model.Methods The clinical data of patients with gastrointestinal bleeding treated with octreotide in our hospital from January 2017 to December 2019 were retrospectively analyzed.The independent risk factors for arrhythmia were analyzed with univariate and Logistic regression multivariate factors,respectively.The relevant nomogram prediction model was established.Results There was no difference in gender,smoking history,drinking history and hyperlipidemia between the two groups(P>0.05).There was significant difference in age,BMI,hypertension,diabetes,coronary heart disease,heart rate slowing history and serum potassium between the two groups(P<0.05).Multivariate Logistic regression analysis showed that BMI had no significant difference(P>0.05).Therefore,age,hypertension,diabetes,coronary heart disease,heart rate slowing history,and serum potassium were selected as independent risk factors(P<0.05).Based on the above 6 independent risk factors,the nomogram model was established and verified.The predicted values of the training set and the validation set were basically consistent with the measured values.The C-index of the training set was 0.844(95%CI:0.812~0.876);the accuracy of the verification set was as high as 81.6%,indicating that the nomogram model had accurate prediction capabilities.Conclusion Many factors may affect the arrhythmia of patients with upper gastrointestinal hemorrhage treated by octreotide.In clinical practice,we should pay more attention to the patients with senior age,hypertension,diabetes,coronary heart disease,heart rate slowing history and serum potassium decrease.