急性肺栓塞治疗后短期复发危险因素的分析及列线图预测模型的构建

Analysis of risk factors for short-term recurrence of acute pulmonary embolism after treatment and construction of a nomogram prediction model

目的:分析急性肺栓塞(APE)治疗后短期复发的危险因素,并构建列线图预测模型。方法:选择2019年1月至2021年6月本院收治的405例APE患者,以APE患者12个月内是否复发分组,即病例组46例APE患者治疗后短期复发,对照组359例APE患者治疗后未短期复发,用Logistic回归分析影响APE治疗后短期复发的危险因素,构建APE治疗后短期复发的列线图预测模型,再用受试者工作特征(ROC)与校准曲线进行模型验证。结果:病例组与对照组在体质量指数、饮酒、高密度脂蛋白(HDL)、脑钠肽(BNP)、肌钙蛋白、严重肺部疾病、长期卧床、恶性肿瘤、免疫疾病、特发性肺栓塞(iPE)、右心功能不全、休克低血症、D-二聚体持续异常方面比较差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,恶性肿瘤(95%CI:1.638~9.209,P=0.002)、免疫疾病(95%CI:1.403~9.749,P=0.008)、右心功能不全(95%CI:1.466~5.429,P=0.002)、D-二聚体持续异常(95%CI:1.152~7.022,P=0.023)为APE治疗后短期复发的独立危险因素(P<0.05)。列线图预测模型ROC曲线下面积为0.728(95%CI:0.648~0.809);校准曲线斜率接近1,H-L拟合优度检验χ^(2)=2.239,P=0.327。结论:基于恶性肿瘤、免疫疾病、右心功能不全、D-二聚体持续异常4项独立危险因素构建的列线图预测模型可有效预测APE治疗后短期复发。

Objective:To analyze the risk factors of short-term recurrence of acute pulmonary embolism(APE)after treatment,and to construct a nomogram prediction model.Methods:APE patients admitted to our hospital from January 2019 to June 2021 were selected and grouped according to whether they had recurrence within 12 months,46 cases in the case group had short-term recurrence of APE after treatment,and 359 cases in the control group had no short-term recurrence of APE after treatment.Logistic regression was used to analyze the risk factors affecting short-term recurrence of APE after treatment,and a nomogram model for predicting short-term recurrence of APE after treatment was constructed,and then the receiver operating characteristic(ROC)and calibration curve were used to verify the model.Results:In the case group and the control group,the body mass index,alcohol consumption,high-density lipoprotein(HDL),brain natriuretic peptide(BNP),troponin,severe pulmonary disease,long-term lying in bed,malignant tumor,immune disease,idiopathic pulmonary embolism(iPE),right ventricular insufficiency,hypovolemic shock,and D-dimer persistent abnormality were obviously different(P<0.05).Logistic regression analysis showed that:malignant tumor(95%CI:1.638-9.209,P=0.002),immune disease(95%CI:1.403-9.749,P=0.008),right ventricular insufficiency(95%CI:1.466-5.429,P=0.002)and D-dimer persistent abnormality(95%CI:1.152-7.022,P=0.023)were independent risk factors for short-term recurrence of APE after treatment(P<0.05).The area under the ROC curve was 0.728(95%CI:0.648-0.809);the slope of the calibration curve was close to 1,the H-L goodness of fit testχ^(2)=2.239,P=0.327.Conclusion:The nomogram prediction model based on four independent risk factors,including malignant tumor,immune disease,right ventricular insufficiency and D-dimer persistent abnormality,can effectively predict short-term recurrence of APE after treatment.