血红蛋白联合心脏超声建立肥厚型心肌病发生肺动脉高压列线图预测模型研究

Hemoglobin combined with cardiac ultrasound to establish a nomogram prediction model for pulmonary hypertension in hypertrophic cardiomyopathy

目的联合血红蛋白及心脏超声利用列线图构建肥厚型心肌病(HCM)发生肺动脉高压(PH)的预测模型。方法回顾性分析2017年1月至2023年3月就诊于新疆医科大学第一附属医院并住院经超声心动图明确诊断为HCM患者151例,根据HCM患者是否发生PH,将患者分为病例组(合并PH的HCM患者,n=25)和对照组(不合并PH的HCM患者,n=126)。收集并分析两组患者的一般资料、基础疾病史、血清学检查指标、超声心动图参数。利用单因素及多因素logistic回归分析得到HCM患者发生PH的独立危险因素并构建预测模型,应用R语言软件(R4.3.2)构建列线图将模型可视化,并绘制受试者特征工作曲线(ROC曲线)对该模型进行验证,评估其对HCM发生PH的预测价值。结果多因素logistic回归分析结果示,HCM患者血红蛋白越低(OR=0.968,95%CI 0.941~0.995)、右心房内径越大(OR=1.132,95%CI 1.010~1.267)、肺动脉内径越大(OR=1.166,95%CI 1.012~1.345)、二尖瓣舒张早期血流峰值速度与二尖瓣环舒张早期运动峰值速度比值(MV-E/e′)越大(OR=1.196,95%CI 1.051~1.361)(均P<0.05),发生PH的风险越高。利用上述指标构建预测模型,利用列线图将模型可视化,经Bootstrap重复抽样1000次内部验证法,发现预测值同实测值基本一致,表示本研究建立的预测模型一致性良好;计算出C-index为0.843(95%CI 0.744~0.942),具有良好的区分度。预测模型的ROC曲线下面积为0.843,预测效能较高。结论血红蛋白越低、右心房内径越大、肺动脉内径越大、MV-E/e′越大的HCM患者发生PH的风险显著增高,本研究构建的列线图模型有助于评估HCM患者发生PH的风险,具有一定的预测效能。

Objective To construct a prediction model for pulmonary hypertension(PH)combining hemoglobin and cardiac ultrasound in patients with hypertrophic cardiomyopathy(HCM)by nomogram.Methods A retrospective analysis was performed for 151 patients diagnosed with HCM by echocardiography in the First Affiliated Hospital of Xinjiang Medical University from January 2017 to March 2023,and the patients were divided into the experimental group(patients with PH,n=25)and control group(patients without PH,n=126)according to whether the patients developed PH.The general data,underlying disease history,serological examination indexes,and echocardiographic parameters of the two groups were collected and analyzed.Univariate and multivariate binary logistic regression analysis were used to obtain the independent risk factors for PH,and a prediction model was constructed;the R software(R4.3.2)was used to construct a nomogram to visualize the model and the receiver characteristic working curve(ROC curve)was drawn to verify the model and evaluate its predictive value for PH developing.Results The results of multivariate logistic regression analysis showed that the lower the hemoglobin in HCM patients(OR=0.968,95%CI 0.941~0.995),the larger the right atrial inner diameter(OR=1.132,95%CI 1.010~1.267),the larger the inner diameter of the pulmonary artery(OR=1.166,95%CI 1.012~1.345),the larger the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus(MV-E/e′)(OR=1.196,95%CI 1.051~1.361)(all P<0.05),the higher the risk of developing PH.The prediction model was constructed using the above indicators;the nomogram was used to visualize the model;and the internal verification method of Bootstrap repeated sampling for 1000 times found that the predicted value was basically consistent with the measured value,indicating that the prediction model established was in good consistency;the C-index was calculated to be 0.843(95%CI 0.744~0.942),which had a good degree of discrimination.The area under the ROC curve of the prediction model is 0.843,which has high prediction efficiency.Conclusion The lower the hemoglobin,the larger the right atrial inner diameter,the larger the pulmonary artery diameter,and the larger the MV-E/e′,the patients had more significantly increased risk of PH;and the nomogram model is helpful to evaluate the risk of PH in HCM patients,which has certain predictive efficacy.