暴发性心肌炎患者早期风险评估模型的建立

Establishment of early risk assessment model for fulminant myocarditis

目的探讨识别成人暴发性心肌炎(FM)的潜在危险因素,建立早期风险评估模型。方法回顾性分析2013—2021年福建医科大学附属第一医院和2017—2021年福建医科大学附属协和医院收治的268例心肌炎患者。使用多因素logistic回归分析FM的危险因素,最后纳入筛选出的独立危险因素建立Nomogram风险评估模型,采用受试者工作特征(ROC)曲线评估风险评估模型的区分度,采用决策曲线分析(DCA)评估风险评估模型的临床实用性。结果本研究共纳入268例心肌炎患者,其中FM 53例,非暴发性心肌炎(NFM)215例。逐步logistic回归分析显示,年龄(OR=1.869,95%CI 1.119~3.120,P=0.017)、传导阻滞/心动过缓(OR=38.700,95%CI 4.191~357.343,P=0.001)、心包积液(微量:OR=29.093,95%CI 0.393~2155.855,P=0.125;少量:OR=12.449,95%CI 1.360~113.976,P=0.026;中量:OR=34.610,95%CI 1.185~1010.446,P=0.040)、氨基末端脑利尿钠肽前体(NT-ProBNP)(OR=1.013,95%CI 1.000~1.025,P=0.042)、心肌肌钙蛋白I(cTnI)(OR=1.170,95%CI 1.008~1.358,P=0.038)、血糖(OR=1.439,95%CI 1.179~1.757,P<0.001)、血钙(OR=0.529,95%CI 0.421~0.665,P=0.017)、左室射血分数(LVEF)(OR=0.484,95%CI 0.264~0.886,P=0.019)是FM的独立影响因素。基于逐步回归分析结果中的8项独立影响因素建立的Nomogram预测模型具有较好的预测能力,其ROC曲线下面积(AUC)为0.95(95%CI 0.94~0.98)。DCA表明,模型在较大的阈值内均有较高的获益性。结论年龄、传导阻滞/心动过缓、心包积液、NT-proBNP、cTnI、血糖、血钙、LVEF是FM的独立影响因素,根据影响因素构建的Nomogram模型对FM有较高的预测价值。

Objective To identify potential risk factors for adult fulminant myocarditis(FM)and establish a early risk assessment model based on significant factors.Methods Retrospective analysis of 268 patients with myocarditis admitted to the first affiliated hospital of Fujian Medical University from 2013-2021 and the Fujian Medical University Union Hospital from 2017-2021.Risk factors for FM identified by multivariate logistic regression analysis were used to create a Nomogram.Receiver operating characteristic curve(ROC)was used to evaluate the differentiation of Nomogram,and decision curve analysis(DCA)was used to evaluate the clinical usefulness.Results Of the 268 patients with myocarditis,215 patients were diagnosed with non-fulminant myocarditis(NFM),and 53 with FM.Stepwise regression analysis showed that age(OR=1.869,95%CI 1.119-3.120,P=0.017),conduction block or bradycardia(OR=38.700,95%CI 4.191-357.343,P=0.001),hydropericardium(trace:OR=29.093,95%CI 0.393-2155.855,P=0.125;small:OR=12.449,95%CI 1.360-113.976,P=0.026;medium:OR=34.610,95%CI 1.185-1010.446,P=0.040),N-terminal pro-B-type natriuretic peptide(NT-proBNP)(OR=1.013,95%CI 1.000-1.025,P=0.042),cardiac troponin I(cTnI)(OR=1.170,95%CI 1.008-1.358,P=0.038),blood glucose(OR=1.439,95%CI 1.179-1.757,P<0.001),blood calcium(OR=0.529,95%CI 0.421-0.665,P=0.017)and left ventricular ejection fraction(LVEF)(OR=0.484,95%CI 0.264-0.886,P=0.019)were independent influencing factors for FM.The Nomogram model based on the eight influencing factors had good prediction effect.The area under the ROC curve(AUC)was 0.95(95%CI 0.94-0.98).Conclusion Age,conduction block or bradycardia,hydropericardium,NT-proBNP,cTnI,blood glucose,blood calcium,and LVEF were independent risk factors for FM,and the Nomogram model constructed on the basis of risk factors had a high predictive value for FM.