肥厚型心肌病患者冠状动脉微循环功能障碍的风险模型构建及验证

Risk model construction and validation of coronary microcirculation dysfunction in patients with hypertrophic cardiomyopathy

目的 探讨肥厚型心肌病(HCM)患者冠状动脉微循环功能障碍的影响因素,并建立预测模型。方法 选取2019年10月—2021年5月我院收治的HCM患者92例,患者均行心脏超声造影检查,根据结果将其分为冠状动脉微循环功能正常组(n=24)和异常组(n=68)。收集患者临床资料,采用单因素和Logistic回归分析HCM患者发生冠状动脉微循环功能障碍的独立危险因素,根据独立危险因素建立风险预测,并通过受试者工作特征(ROC)曲线、Hosmer-Lemeshow goodness-of-fit检验和临床决策曲线评价模型的区分度、准确度和有效性。结果 与冠状动脉微循环功能正常组比较,异常组NYHA分级更劣,淋巴细胞计数、LDL-C、Alb及LVEF显著降低,hs-CRP、NT-proBNP、Cys-C、hs-cTnI、LVEDD及LAD显著增加(P<0.05)。NYHA分级越高、LVEF降低及NT-proBNP、hs-cTnI、LVEDD增加均为HCM患者并发冠状动脉微循环功能障碍的独立危险因素(P<0.05)。利用以上独立危险因素构建Nomogram预测模型,其一致性指数(C-index)为0.756(95%CI:0.684~0.830),ROC曲线AUC为0.895(95%CI:0.866~0.915),具有较好的区分度;校准曲线及临床决策曲线评价结果提示模型准确性及有效性均较好。结论 NYHA分级越高、LVEF降低及NT-proBNP、hs-cTnI、LVEDD增加均为HCM患者并发冠状动脉微循环功能障碍的独立危险因素,所建立的Nomogram预测模型对风险评估具有一定的参考价值。

Objective To explore the influencing factors of coronary microcirculation dysfunction in patients with hypertrophic cardiomyopathy(HCM)and establish a prediction model.Methods 92 patients with HCM treated in our hospital from October 2019 to may 2021 were selected.All patients underwent cardiac contrast-enhanced ultrasound examination and were divided into coronary microcirculation dysfunction group(n=24)and normal group(n=68)according to the results.The clinical data of patients were collected,and the independent risk factors of coronary microcirculation dysfunction in HCM patients were analyzed by single factor and logistic regression.The risk prediction was established according to the independent risk factors,and the differentiation,accuracy and effectiveness of the model were evaluated by receiver operating characteristic(ROC)curve,Hosmer lemeshow goodness of fit test and clinical decision-making curve.Results Compared with the normal coronary microcirculation group,the NYHA grade in the abnormal group was worse,the lymphocyte count,LDL-C,ALB and LVEF decreased significantly,and hs-CRP,NT-proBNP,Cys-C,hs-cTnI,LVEDD and LAD increased significantly(P<0.05).The higher NYHA grade,the lower LVEF and the increase of NT-proBNP,hs-cTnI and LVEDD were independent risk factors for coronary microcirculation dysfunction in patients with HCM(P<0.05).The nomogram prediction model was constructed by using the above independent risk factors.The consistency index(c-index)was 0.756(95%CI:0.684~0.830),and the AUC of ROC curve was 0.895(95%CI:0.866~0.915).The evaluation results of calibration curve and clinical decision curve suggest that the accuracy and effectiveness of the model are good.Conclusion The higher NYHA grade,the lower LVEF and the increase of NT-proBNP,hs-cTnI and LVEDD are independent risk factors of coronary microcirculation dysfunction in patients with HCM,the nomogram prediction model has a certain reference value for risk assessment.