基于Markov模型的中西医结合治疗心力衰竭远期疗效评价研究

Evaluation of Long-term Effect of Integrated Traditional Chinese and Western Medicine on Heart Failure based on Markov Model

目的 应用马尔科夫(Markov)模型评价中西医结合治疗对心力衰竭患者远期临床结局的影响,探讨Markov模型在心力衰竭领域的适用性。方法 通过中日友好医院病历系统进行回顾性的信息检索,筛选2016年7月至2021年1月就诊于中日友好医院中西医结合心内科的心力衰竭住院患者。共纳入符合标准的心力衰竭患者161例,根据治疗方式将其分为常规西药治疗组67例和中西医结合治疗组94例。记录患者一般资料、实验室指标及心功能指标,以6个月为1个周期评估患者出院后心功能分级变化情况,并记录有无复合心血管事件发生。依据真实随访数据构建Markov模型,预测队列患者治疗1、3、5年后心功能情况及最终健康效用值,并与真实情况比较验证模型真实性。结果 中西医结合治疗组患者年龄相对常规西药治疗组更大(P=0.019)。以Markov模型模拟1、3、5年的疾病发展,预测中西医结合治疗组发生心血管事件概率分别为4.8%、6.0%、6.2%,估计健康效用值分别为0.161、0.167、0.083;常规西药治疗组发生心血管事件概率分别为14.4%、21.5%、24.3%,估计健康效用值分别为0.126、0.117、0.057;中西医结合治疗组患者整体心功能水平优于常规西药治疗组,且各时点心血管事件发生率均更低(P<0.001)。治疗1年时心功能的模型预测频率与实际随访频率比较,常规西药治疗组(P=0.351)与中西医结合治疗组(P=0.077)差异均无统计学意义。结论 中西医结合治疗相比于常规西药治疗心力衰竭具有更好的远期临床疗效,Markov模型可较好适用于心力衰竭领域。

ABSATRACT Objective To evaluate the long-term effect of integrated traditional Chinese and western medicine on the clinical outcomes of heart failure(HF) patients using Markov model,and to explore the applicability of Markov model in the field of HD.Methods The clinical data of HF inpatients in the department of integrated traditional Chinese and western medicine in China-Japan Friendship Hospital from July 2016 to January 2021 was retrospectively collected through the medical record system of the hospital.A total of 161 patients with HF who met the criteria were included,and were divided into 67 patients in the conventional(western medicine) treatment group and 94 patients in the integrated(traditional Chinese and western medicine) treatment group according to the treatment received.The general information,laboratory indicators and cardiac function indicators were recorded,while the changes of cardiac function grade after discharge were evaluated every six months,and the occurrence of composite cardiovascular events was recorded.Markov models were constructed based on real follow-up data to predict the 1 y-,3 y-and 5 y-cardiac function and final health state utility values(HSUVs),and to verify the authenticity of the models compared with the real condition.Results Relatively older patients were found in the integrated treatment group than the conventional treatment group(P=0.019).Using a Markov model to simulate 1 y-,3 y-and 5 y-disease progression,the corresponding occurrence rates of cardiovascular events were predicted to be 4.8%,6.0%,and 6.2%,and the HSUVs were0.161,0.167,and 0.083 in the integrated treatment group,while those were 14.4%,21.5%,and 24.3%,and0.126,0.117,and 0.057 in the conventional treatment group.Patients in the integrated treatment group had better overall cardiac function and a lower incidence of cardiovascular events at all time points than those in the conventional treatment group(P<0.001).Comparing the model-predicted frequency of cardiac function with the actual frequency of follow-up at one year of treatment,there was no statistically significant difference between the conventional treatment group(P=0.351) and the integrated treatment group(P=0.077).Conclusion Integrated traditional Chinese and western medicine has a better long-term effect on HF compared with conventional western medicine therapy,and Markov model can be used in the field of HF.