冠脉介入后心绞痛患者心力衰竭的Nomogram风险模型构建及重要性矩阵分析

Construction of Nomogram risk model and importance matrix analysis of heart failure in patients with angina pectoris after coronary intervention

目的探讨冠脉介入后心绞痛患者心力衰竭(HF)的影响因素,并构建Nomogram风险模型及重要性矩阵。方法前瞻性选取2017年8月至2023年8月于开封市中医院行冠脉介入后的568例心绞痛患者作为研究对象,按照冠脉介入后6个月是否并发HF分为发生组92例和未发生组476例。比较两组患者的临床资料,采用Logistic回归模型分析冠脉介入后心绞痛患者HF的影响因素,构建Nomogram预测模型,采用受试者工作特征(ROC)曲线、决策曲线、校正曲线验证Nomogram预测模型预测价值和临床效用,并进一步进行重要性矩阵分析。结果发生组患者合并高血压、单支病变血管数例数占比分别为61.96%、26.09%,明显高于未发生组的37.61%、13.87%,发病至手术时间为(9.21±2.41)h,明显长于未发生组的(6.75±1.87)h,差异均有统计学意义(P<0.05);发生组患者术后心肌梗死溶栓试验(TIMI)血流分级0~1级、2级例数占比分别为4.35%、18.48%,明显高于未发生组的1.05%、9.03%,差异均有统计学意义(P<0.05);发生组患者的醛固酮(Ald)、B型脑利钠肽(BNP)、C1q肿瘤坏死因子相关蛋白1(CTRP1)、内脏脂肪素(Visfatin)、氧化低密度脂蛋白(ox-LDL)水平分别为(214.67±34.19)μg/L、(2143.65±234.15)pg/mL、(12.88±2.67)ng/mL、(15.26±3.66)ng/mL、(52.39±7.85)U/L,明显高于未发生组的(179.52±25.39)μg/L、(786.34±187.96)pg/mL、(9.52±2.14)ng/mL、(12.39±2.74)ng/mL、(45.79±6.47)U/L,差异均有统计学意义(P<0.05);发生组患者的血红蛋白(Hb)、淋巴细胞计数(LC)水平分别为(5.88±1.06)g/L、(1.42±0.36)×10^(9)/L,明显低于未发生组的(9.76±2.28)g/L、(1.75±0.41)×10^(9)/L,差异均有统计学意义(P<0.05);发生组患者的自我管理能力评分为(72.36±20.17)分,明显低于未发生组的(105.47±23.74)分,差异有统计学意义(P<0.05);Logistic回归模型分析结果提示,合并高血压、发病至手术时间、BNP、CTRP1、Visfatin、Ox-LDL均是冠脉介入后心绞痛患者发生HF的危险因素(P<0.05),而术后TIMI血流分级、LC、自我管理能力是冠脉介入后心绞痛患者发生HF的保护因素(P<0.05);基于上述各项影响因素建立Nomogram模型,ROC曲线下面积(AUC)为0.826(95%CI:0.780~0.873);DCA曲线提示,当风险阈值在0.22~0.83时使用该模型具有较好的临床净获益;合并高血压、CTRP1、自我管理能力的重要性较高,改善难度较低,纳入优先改进区域。结论合并高血压、发病至手术时间、BNP、CTRP1、Visfatin、Ox-LDL是冠脉介入后心绞痛患者发生HF的危险因素,术后TIMI血流分级、LC、自我管理能力是冠脉介入后心绞痛患者发生HF的保护因素,基于上述影响因素构建的Nomogram风险模型敏感度较高,临床可据此制定个性化防治措施,便于进一步改善预后。

Objective To explore the influencing factors of heart failure(HF)in patients with angina pectoris after coronary intervention,and construct a Nomogram risk model and importance matrix.Methods A prospective study was conducted on 568 patients with angina pectoris who underwent coronary intervention at Kaifeng Traditional Chinese Medicine Hospital from August 2017 to August 2023.These patients were divided into a group of 92 cases with HF complications and a group of 476 cases without HF complications,based on whether they developed HF complications within six months after coronary intervention.The clinical data of the two groups were compared,and the logistic regression model was used to analyze the influencing factors of HF in patients with angina pectoris after coronary intervention.The Nomogram prediction model was constructed,and the receiver operating characteristic(ROC)curve,decision gram prediction model.Furthermore,an importance matrix analysis was conducted.Results The proportions of patients with hypertension and single-vessel lesions in the group with complications were 61.96%and 26.09%,respectively,which were significantly higher than 37.61%and 13.87%in the group without complications(P<0.05).The time from onset to surgery was(9.21±2.41)hours,which was significantly longer than(6.75±1.87)hours in the group without complications(P<0.05).The proportions of patients with postoperative thrombolysis in myocardial infarction(TIMI)flow grade 0-1 and grade 2 in the group with complications were 4.35%and 18.48%,respectively,which were significantly higher than 1.05%and 9.03%in the group without complications(P<0.05).The levels of aldosterone(Ald),B-type natriuretic peptide(BNP),C1q tumor necrosis factor-related protein 1(CTRP1),visfatin,and oxidized low-density lipoprotein(ox-LDL)in the group with complications were(214.67±34.19)μg/L,(2143.65±234.15)pg/mL,(12.88±2.67)ng/mL,(15.26±3.66)ng/mL,and(52.39±7.85)U/L,respectively,which were significantly higher than(179.52±25.39)μg/L,(786.34±187.96)pg/mL,(9.52±2.14)ng/mL,(12.39±2.74)ng/mL,and(45.79±6.47)U/L in the group without complications(P<0.05).The hemoglobin(Hb)and lymphocyte count(LC)levels in the group with complications were(5.88±1.06)g/L and(1.42±0.36)×10^(9)/L,respectively,which were significantly lower than(9.76±2.28)g/L and(1.75±0.41)×10^(9)/L in the group without complications(P<0.05).The self-management ability score in the group with complications was(72.36±20.17)points,which was significantly lower than(105.47±23.74)points in the group without complications(P<0.05).Logistic regression analysis showed that the presence of hypertension,the time from onset to surgery,BNP,CTRP1,visfatin,and Ox-LDL were all risk factors for the development of HF in patients with angina pectoris after coronary intervention(P<0.05),while the postoperative TIMI flow classification,LC,and self-management ability were protective factors for the development of HF in patients with angina pectoris after coronary intervention(P<0.05).A Nomogram model was established based on the above factors,with an area under the ROC curve(AUC)of(95%CI:0.780-0.873).The DCA revealed that this model has a good clinical net benefit when the risk threshold was between 0.22 and 0.83.Complication of hypertension,CTRP1,and self-management ability were of high importance and easier to improve,which should be included in the priority improvement areas.Conclusion The complication of hypertension,time from onset to surgery,BNP,CTRP1,visfatin,and Ox-LDL are risk factors for the development of HF in patients with angina pectoris after coronary intervention.Postoperative TIMI flow classification,LC,and self-management ability are protective factors for the development of HF in patients with angina pectoris after coronary intervention.The Nomogram risk model constructed based on the above influencing factors has high sensitivity and can be used to develop personalized prevention and treatment measures for further improvement of prognosis.