心功能不全合并下肢动脉硬化闭塞症的危险因素及列线图模型的建立

Risk factors and establishment of nomogram model for cardiac insufficiency combined with arteriosclerosis obliterans

目的探讨心功能不全患者发生下肢动脉硬化闭塞症(ASO)的危险因素,构建及验证列线图风险预测模型。方法选取心功能不全患者319例,依据下肢动脉彩超结果是否存在下肢动脉狭窄或闭塞分为ASO阳性组(161例)和ASO阴性组(158例)。收集患者性别、年龄、吸烟史、饮酒史、高血压史、美国纽约心脏病协会(NYHA)心功能分级,入院后三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(HCY)、糖化血红蛋白(HbA1c)、N末端B型利钠肽前体(NT-proBNP)、高敏肌钙蛋白T(hs-cTnT)、踝肱指数(ABI)、左心室射血分数(LVEF)等指标。采用Logistic回归分析心功能不全患者发生ASO的危险因素,构建并验证列线图风险预测模型。结果与ASO阴性组比较,ASO阳性组男性比例、高血压患病比例、吸烟率、NYHA心功能Ⅱ~Ⅲ级比例、HbA1c、TG、TC、LDL-C、HCY水平升高,ABI降低(P<0.05)。Logistic回归分析显示,男性、高血压、吸烟以及较高水平的TG、TC、LDL-C、HCY,NYHA心功能Ⅱ~Ⅲ级为心功能不全患者发生ASO的独立危险因素。据此构建的列线图模型采用Bootstrap内部验证,Hosmer-Lemeshow检验结果示模型拟合优度较好(χ^(2)=0.602,P>0.05),C-index为0.856(95%CI:0.815~0.896)。Spearman相关分析显示,ABI与LVEF呈正相关(r_(s)=0.228,P<0.01),与NYHA心功能分级、NT-proBNP及hs-cTnT呈负相关(r_(s)分别为-0.296、-0.303及-0.268,P<0.01)。结论男性、高血压、吸烟以及较高水平的TG、TC、LDL-C、HCY,NYHA心功能Ⅱ~Ⅲ级是心功能不全患者发生ASO的独立危险因素,建立的列线图预测模型可有效评估心功能不全患者发生ASO的风险。

Objective To investigate the risk factors of arteriosclerosis obliterans(ASO)in patients with cardiac insufficiency,and to construct and verify the nomogram risk prediction model.Methods A total of 319 patients with cardiac insufficiency were selected.According to whether there was lower extremity arterial stenosis or occlusion in the lower extremity,patients were divided into the ASO positive group(n=161)and the ASO negative group(n=158).Gender,age,history of smoking,history of drinking,history of hypertension,New York heart association(NYHA)cardiac function grade,triglycerides(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),homocysteine(HCY),glycosylated hemoglobin(HbA1c),N-terminal pro-brain natriuretic peptide(NT-proBNP),high sensitivity cardiac troponin T(hs-cTnT),ankle-brachial index(ABI)and left ventricular ejection fraction(LVEF)were collected after admission.Logistic regression was used to analyze the risk factors of ASO in patients with cardiac insufficiency,so as to establish and verify the nomogram risk prediction model.Results Compared with the ASO negative group,the ASO positive group had higher male ratio,high proportion of hypertension,higher smoking rate,high proportion of NYHA cardiac function gradeⅡ-Ⅲ,higher levels of HbA1c,TG,TC,LDL-C and HCY,and lower ABI(P<0.05).Logistic regression analysis showed that male,hypertension,smoking,NYHA cardiac function gradeⅡ-Ⅲ,higher levels of TG,TC,LDL-C,and HCY were independent risk factors for ASO in patients with cardiac insufficiency.The nomogram risk prediction model constructed on this basis was verified by Bootstrap internal verification.The Hosmer-Lemeshow test showed that the model had good goodness of fit(χ^(2)=0.602,P>0.05).The C-index of the model was 0.856(95%CI:0.815-0.896).Spearman correlation analysis showed that LVEF was positively correlated with ABI(r_(s)=0.228,P<0.01).NYHA cardiac function grade,NT-proBNP and hs-cTnT were negatively correlated with ABI(r_(s)=-0.296,-0.303 and-0.268,P<0.01).Conclusion Male,hypertension,smoking,NYHA cardiac function gradeⅡ-Ⅲ,higher levels of TG,TC,LDL-C and HCY are independent risk factors for ASO in patients with cardiac insufficiency.The established nomogram prediction model could effectively assess the risk of ASO in patients with cardiac insufficiency.