基于列线图评价代谢相关脂肪性肝病与高血压心脑血管事件的关系

Evaluation of the relationship between metabolic associated fatty liver disease and cardio-cerebrovascular events in patients with hypertension based on nomogram

目的探讨高血压患者代谢相关脂肪性肝病(metabolic associated fatty liver disease,MAFLD)的临床特点以及与心脑血管事件发生的关系。方法回顾性分析2019年1月至2022年10月上海市徐汇区大华医院1385例高血压患者的临床资料,根据是否存在MAFLD分为MAFLD组和非MAFLD组,比较两组病例的一般临床资料、实验室和辅助检查相关指标以及临床转归的差异。采用二元logistic回归,分析高血压患者心脑血管事件发生的风险因素。心脑血管事件定义为各种致命或非致命性的心脑血管事件,包括心绞痛、心肌梗死、脑卒中、心脑血管死亡和需要住院或治疗的心力衰竭。采用列线图(nomogram)呈现logistic回归模型确认的心脑血管事件发生的独立风险因素。一致性指数(C-index)和bootstrap重抽样技术评估nomogram的预测能力。结果1385例高血压患者中,MAFLD组患者为514例,非MAFLD组患者为871例。MAFLD组更多为男性,具有更高的饮酒率,更高的2型糖尿病和房颤比例,更高的体质指数、24 h平均收缩压/舒张压、总胆固醇、甘油三酯和低密度脂蛋白水平,更低的高密度脂蛋白水平,以及更高的心血管事件发生率(24.7%vs 17.8%)(P<0.05)。经单因素和多因素logistic分析显示,年龄、吸烟史、房颤、MAFLD、2型糖尿病、24 h平均收缩压、总胆固醇、高密度脂蛋白、低密度脂蛋白以及肾小球滤过率是影响高血压心脑血管事件的独立因素(P<0.05)。将上述独立风险因素构建列线图,校准曲线显示模型对于心脑血管事件发生的预测值与实际观察值之间具有良好的一致性,C-index为0.70(95%CI:0.65~0.72)。结论高血压人群中,MAFLD患者更可能为男性,更可能存在不良生活方式、血脂代谢异常以及合并症。MAFLD与高血压群体心脑血管事件的发生具有独立相关性。

Objective To investigate the clinical features of metabolic associated fatty liver disease(MAFLD)in patients with hypertension and its relationship with cardio-cerebrovascular events.Methods The clinical data of 1385 patients with hypertension in Dahua Hospital,Xuhui District,Shanghai from January 2019 to October 2022 were retrospectively analyzed.The enrolled cases were divided into MAFLD group and non-MAFLD group according to the presence or absence of MAFLD,and the general clinical characteristics of the two groups were compared.The risk factors of cardio-cerebrovascular events in hypertensive patients were analyzed by the binary logistic regression method.Cardio-cerebrovascular events were defined as fatal or non-fatal cardiovascular and cerebrovascular events,including angina,myocardial infarction,stroke,cardiovascular and cerebrovascular death,and heart failure requiring hospitalization or treatment.The independent risk factors of cardio-cerebrovascular events identified by logistic regression were demonstrated by a nomogram model.The concordance index(C-index)and bootstrap resampling were used to evaluate the predictive ability of the nomogram.Results Among the 1385 hypertensive patients,514 patients were assigned to the MAFLD group,and 871 patients were to the non-MAFLD group.The patients in the MAFLD group were significantly linked to more male gender and higher rates of alcohol consumption,type 2 diabetes and atrial fibrillation,higher levels of body mass index,24h mean systolic/diastolic blood pressure,total cholesterol,triglycerides and low-density lipoprotein(LDL),lower level of high-density lipoprotein(HDL),and higher incidence of cardio-cerebrovascular events(24.7%vs 17.8%)(P<0.05),when compared to the non-MAFLD group.Univariate and multivariate logistic regression analysis showed that age,smoking,atrial fibrillation,MAFLD,type 2 diabetes,24h mean systolic blood pressure,total cholesterol,HDL,LDL and glomerular filtration rate were independent factors affecting cardio-cerebrovascular events in hypertension population(P<0.05).The independent risk factors were used to construct a nomogram model,and the calibration curve showed good agreement between the predicted value and the actual observed value.The C-index was 0.70(95%confidence interval,0.65-0.72).Conclusion In the hypertension population,patients with MAFLD are more likely to be male,and inclined to have unhealthy lifestyles,suffer from abnormal blood lipid metabolism and comorbidities.MAFLD is independently correlated with cardio-cerebrovascular events in a hypertension population.