冠心病患者D-二聚体/纤维蛋白原比值与心外膜脂肪层厚度的相关性分析

Correlation between D-dimer/fibrinogen ratio and epicardial fat layer thickness in patients with coronary heart disease

目的探究冠心病患者D-二聚体/纤维蛋白原比值(D/F)与心外膜脂肪层厚度(EAT)的相关性。方法选择2020年9月~2021年9月于四川省科学城医院心血管内科因疑似冠心病住院并行冠状动脉造影检查的257例患者为研究对象,采用计算机产生随机数法以3∶1的比例分为训练集(193例)和测试集(64例)。根训练集据患者有无冠心病分为冠心病组(118例)和非冠心病组(75例)。通过单因素和多因素分析冠心病的独立危险因素。依据病情程度将冠心病组患者分为轻度组(30例)、中度组(46例)和重度组(42例)三个亚组,探究各危险因素与病情程度的关系。通过Pearson分析各相关因素与病情程度的关系,并分析不同病情程度患者D/F和EAT的相关性。依据独立危险因素构建列线图预测模型,并对模型进行验证。结果体重指数(BMI)、Gensini积分、EAT、D-二聚体(D-D)、纤维蛋白原(FIB)和D/F为冠心病的独立危险因素(P<0.05)。D/F和EAT与Gensini积分呈显著正相关关系(P<0.05),不同病情程度的冠心病患者的D/F和EAT之间均存在显著正相关关系(P<0.05),且随着病情严重,相关关系越强。而非冠心病人群中D/F和EAT之间不存在显著相关关系(P>0.05)。利用独立危险因素构建列线图预测模型,训练集和测试集的一致性指数(C-index)分别为0.843(95%CI 0.825~0.860)和0.845(95%CI 0.798~0.872),ROC曲线下面积(AUC)分别为0.851(95%CI 0.839~0.872)和0.847(95%CI 0.832~0.869),模型具有较好的区分度,校准曲线评价结果提示模型准确性较高。结论BMI、Gensini积分、EAT、D-D、FIB和D/F为冠心病的独立危险因素,冠心病患者的D/F和EAT具有显著的正相关关系,且病情越严重,相关关系越强。

Objective To explore the correlation between D-Dimer/Fibrinogen ratio(D/F)and epicardial adipose layer thickness(EAT)in the patients with coronary heart disease.Methods From September 2020 to September 2021,257 patients hospitalized in the cardiovascular department of our hospital for suspected coronary heart disease and underwent coronary angiography were selected as the research objects.The computer generated random number method was used to divide the training set(193 cases)and the test set(64 cases)at a ratio of 3∶1.According to whether the patients had coronary heart disease or not,they were divided into coronary heart disease group(n=118)and non coronary heart disease group(n=75).The independent risk factors of coronary heart disease were analyzed by Univariate and Multivariate analysis.The patients with coronary heart disease were divided into mild group(n=30),moderate group(n=46)and severe group(n=42)according to the severity of the disease,and the relationship between the risk factors and the severity of the disease was explored.Pearson was used to analyze the relationship between various related factors and disease severity,and the correlation between D/F and EAT in the patients with different disease severity was analyzed.According to the independent risk factors,the nomogram prediction model was constructed and verified.Results Body mass index(BMI),Gensini,EAT,D-Dimer(D-D),fibrinogen(FIB)and D/F were the independent risk factors for coronary heart disease(P<0.05).D/F and EAT were significantly positively correlated with Gensini score(P<0.05).There was a significant positive correlation between D/F and EAT in the patients with coronary heart disease of different severity(P<0.05),and the correlation became stronger with the severity of the disease.There was no significant correlation between D/F and EAT in the non coronary heart disease population(P>0.05).The nomogram prediction model was constructed by using independent risk factors.The consistency index(C-index)of the training set and the test set were 0.843(95%CI0.825-0.860)and 0.845(95%CI 0.798-0.872),respectively.The area under the ROC curve(AUC)was 0.851(95%CI 0.839-0.872)and 0.847(95%CI 0.832-0.869),respectively.The model had good discrimination,and the evaluation results of the calibration curve suggested that the model had higher accuracy.Conclusion BMI,Gensini,EAT,D-D,FIB and D/F are the independent risk factors of coronary heart disease.D/F and EAT in the patients with coronary heart disease have a significant positive correlation,and the more serious the condition,the stronger the correlation.