老年慢性阻塞性肺疾病患者并发心房颤动的危险因素及其列线图模型构建

Risk Factors and Nomogram Model Construction of Atrial Fibrillation in Elderly Patients with Chronic Obstructive Pulmonary Disease

背景近年随着我国老龄化加重,慢性阻塞性肺疾病(COPD)合并心房颤动(AF)患者数量不断增加,继而带来更加沉重的医疗负担。因此,早期识别伴有AF高风险的老年COPD患者并积极干预具有重要意义。目的探讨老年COPD患者并发AF的危险因素,并构建列线图模型,以期能早期识别伴有AF高风险的老年COPD患者。方法选取2019年1月至2021年5月在扬州大学附属医院住院的老年COPD患者254例,根据患者是否并发AF分为AF组(n=39)和非AF组(n=215)。比较两组患者临床资料,老年COPD患者并发AF的影响因素分析采用多因素Logistic回归分析,采用R语言软件构建老年COPD患者并发AF的列线图模型;绘制受试者工作特征(ROC)曲线以评估该列线图模型对老年COPD患者并发AF的区分度,采用Hosmer-Lemeshow拟合优度检验验证该列线图模型对老年COPD患者并发AF的校准度。结果 AF组患者吸烟率、饮酒率及心力衰竭、糖尿病、急性呼吸衰竭、肺部感染、脑卒中、急性心肌梗死发生率高于非AF组(P <0.05)。多因素Logistic回归分析结果显示,心力衰竭、糖尿病、急性呼吸衰竭、肺部感染、脑卒中及急性心肌梗死是老年COPD并发AF的危险因素(P <0.05)。基于上述危险因素构建老年COPD患者并发AF的列线图模型。ROC曲线分析结果显示,该列线图模型预测老年COPD患者并发AF的曲线下面积(AUC)为0.809[95%CI(0.752,0.865)]。Hosmer-Lemeshow拟合优度检验结果显示,预测值与实际值比较,差异无统计学意义(P> 0.05)。结论心力衰竭、糖尿病、急性呼吸衰竭、肺部感染、脑卒中及急性心肌梗死是老年COPD患者并发AF的危险因素,而基于上述危险因素构建的列线图模型对老年COPD患者并发AF的区分度及校准度良好。

Background In recent years,with the aggravation of aging in China,the number of patients with chronic obstructive pulmonary disease(COPD)complicated with atrial fibrillation(AF)is increasing,which brings more heavy medical burden.Therefore,early identification of elderly COPD patients with high risk of AF and active intervention are of great significance.Objective To explore the risk factors of AF in elderly COPD patients,and construct nomogram model,in order to identify elderly COPD patients with high risk of AF.Methods A total of 254 elderly COPD patients hospitalized in the Affiliated Hospital of Yangzhou University from January 2019 to May 2021 were selected.They were divided into AF group(n=39)and non AF group(n=215)according to whether complicated with AF.The clinical data of the two groups were compared.The influencing factors of AF in elderly patients with COPD were analyzed by multivariate Logistic regression analysis,and the nomogram model of AF in elderly patients with COPD was constructed by R language software;the receiver operating characteristic(ROC)curve was drawn to evaluate the discrimination of the nomogram model of AF in elderly patients with COPD,the Hosmer-Lemeshow goodness of fit test was used to verify the calibration of the nomogram model of AF in elderly patients with COPD.Results The smoking rate,drinking rate,and incidence of heart failure,diabetes mellitus,acute respiratory failure,pulmonary infection,stroke and acute myocardial infarction in AF group were higher than those in non AF group(P<0.05).Multivariate Logistic regression analysis showed that heart failure,diabetes mellitus,acute respiratory failure,pulmonary infection,stroke and acute myocardial infarction were risk factors of AF in elderly patients with COPD(P<0.05).Based on the above risk factors,a nomogram model of AF in elderly patients with COPD was constructed.ROC curve analysis results showed that the area under curve(AUC)of the nomogram model predicting AF in elderly patients with COPD was 0.809[95%CI(0.752,0.865)].Hosmer-Lemeshow goodness of fit test showed that there was no significant difference between the predicted value and the actual value P(>0.05).Conclusion The results of this study suggest that heart failure,diabetes mellitus,acute respiratory failure,pulmonary infection,stroke and acute myocardial infarction are risk factors of AF in elderly patients with COPD.The nomogram model constructed based on the above risk factors has good discrimination and calibration for the risk of AF in elderly patients with COPD.