维持性血液透析患者左心室舒张功能障碍的危险因素及预测模型

Risk factors and prediction model of left ventricular diastolic dysfunction in maintenance hemodialysis patients

目的:探讨维持性血液透析(MHD)患者并发左室舒张功能障碍(LVDD)的危险因素及预测模型建立。方法:选取2019至2020年在徐州医科大学附属医院血液净化中心治疗的75例MHD患者。收集患者的临床指标,实验室及影像学检查资料。采用单因素分析及二元logistic回归分析筛选MHD患者LVDD的独立危险因素。联合各独立危险因素建立LVDD的预测模型并检验模型的预测作用。结果:单因素分析及二元Logistic回归分析显示,超敏肌钙蛋白T(hs-cTnT)、左室质量指数(LVMI)是LVDD的独立危险因素。根据LVDD独立危险因素建立预测模型,当危险因素的总分值>0.406时,诊断的灵敏度为90.24%、特异度为73.53%。受试者工作特征曲线(ROC)下面积为0.871(P<0.01)。结论:hs-cTnT、LVMI为MHD患者LVDD的独立危险因素。基于患者独立危险因素建立的预测模型优于单一指标,对LVDD有良好的预测效能。可为MHD患者LVDD的早期预测及治疗提供临床参考。

Objective:To explore the risk factors of left ventricular diastolic dysfunction(LVDD) in maintenance hemodialysis(MHD) patients and establish a predictive model of LVDD. Methodology:A total of 75 MHD patients, treated in the Blood Purification Center of the affiliated Hospital of Xuzhou Medical University from 2019 to 2020,were selected as subjects. The clinical indicators, laboratory and imaging data of the patients were collected. Univariate analysis and binary logistic regression analysis were used to screen the independent risk factors of LVDD in patients with MHD. The predictive model of LVDD was established by combining independent risk factors and its predictive value was tested. Results:Univariate analysis and binary Logistic regression analysis showed that high-sensitive cardiac troponin T(hs-cTnT) and left ventricular mass index(LVMI) were independent risk factors for LVDD. According to the independent risk factors of LVDD,a predictive model was established. When the total score of risk factors was more than 0.406,the sensitivity and specificity of diagnosis were 90.24% and 73.53% respectively. The area under the receiver operator characteristic(ROC) was 0.871(P<0.01). Conclusion:Hs-cTnT and LVMI are independent risk factors for LVDD in MHD patients. The prediction model based on independent risk factors is better than a single index, and has a good prediction efficiency for LVDD.