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射血分数保留型心力衰竭患者冠状动脉微循环阻力的影响因素

Influencing factors of coronary microcirculation resistance in patients with preserved ejection fraction heart failure
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摘要 目的探讨射血分数保留型心力衰竭(HFpEF)患者冠状动脉微循环阻力(IMR)的影响因素。方法选择本院在2018年9月~2021年3月期间收治的239例HFpEF患者作为研究对象,根据患者IMR值分为IMR正常组(n=151)和IMR升高组(n=88),分析HFpEF患者IMR升高的影响因素,构建Logistic回归模型,并分析模型效能和稳定性。结果IMR升高组糖尿病患者比例显著高于IMR正常组(P<0.01),一般运动强度比例高于IMR正常组,中高度运动强度比例低于IMR正常组(P<0.01)。IMR升高组患者hs-CRP、IL-8、TNF-α、HbA1c及BNP显著高于IMR正常组,而HDL-C水平显著低于IMR正常组(均P<0.01)。多因素Logistic回归分析结果显示,hs-CRP和TNF-α水平是IMR升高的危险因素;运动强度和HDL-C是IMR升高的保护因素。运动强度在训练集和验证集上均具有最大的C指数,分别为0.757和0.768。运动强度、hs-CRP、TNF-α及HDL-C水平4个因素构成的模型C指数在训练集和验证集中分别为0.886和0.898,均高于其他模型。模型最高约登指数为0.746,相对应的灵敏度为87.8%,特异度为86.8%,准确度为87.3%。通过十字交叉验证来验证预测模型的稳定性,结果表明训练集和验证集的参数非常接近。结论运动强度、hs-CRP、IL-8、TNF-α、HbA1c、BNP及HDL-C水平对HFpEF患者非狭窄IMR影响显著;hs-CRP和TNF-α水平是IMR升高的危险因素,运动强度和HDL-C是IMR升高的保护因素;根据运动强度、HDL-C、TNF-α及hs-CRP水平构建的Logistic回归模型预测IMR升高的概率,模型预测效能和稳定性良好。 AIM To investigate the influencing factors of coronary microcirculation resistance(IMR)in patients with ejection fraction preserved heart failure(HFpEF).METHODS 239 HFpEF patients admitted to our hospital between September 2018 and March 2021 were selected as the study subjects.They were divided into two groups based on their IMR values:a normal IMR group(n=151)and an elevated IMR group(n=88).The influencing factors of IMR elevation in HFpEF patients were analyzed,and a logistic regression model was constructed to analyze the model’s efficacy and stability.RESULTS The proportion of diabetes patients in the IMR elevated group was significantly higher than that in the IMR normal group(P<0.01),the proportion of general exercise intensity was higher than that in the IMR normal group,and the proportion of medium and high exercise intensity was lower than that in the IMR normal group(P<0.01).Hs CRP,IL-8,TNF in patients with elevated IMR-α、HbA1c and BNP were significantly higher in the IMR normal group,while HDL-C levels were significantly lower in the IMR normal group(both P<0.01).The results of multivariate logistic regression analysis showed that hs CRP and TNF-αLevel is a risk factor for increased IMR;Exercise intensity and HDL-C are protective factors for increased IMR.The exercise intensity has the highest C-index on both the training and validation sets,with values of 0.757 and 0.768,respectively.Exercise intensity,hs CRP,TNF-αThe C index of the model composed of four factors including HDL-C level was 0.886 and 0.898 in the training and validation sets,respectively,which were higher than other models.The highest Jordan index of the model is 0.746,with a corresponding sensitivity of 87.8%,specificity of 86.8%,and accuracy of 87.3%.The stability of the prediction model was verified through cross validation,and the results showed that the parameters of the training and validation sets were very close.CONCLUSION Exercise intensity,hs CRP,IL-8,TNF-α、The levels of HbA1c,BNP,and HDL-C have a significant impact on non stenosis IMR in HFpEF patients;Hs CRP and TNF-αLevel is a risk factor for IMR elevation,while exercise intensity and HDL-C are protective factors for IMR elevation;Based on exercise intensity,HDL-C,TNF-αThe logistic regression model constructed at the hs CRP level predicts the probability of an increase in IMR,with good predictive performance and stability.
作者 金新 王楠 刘晓静 张华 薛蕊 张静 刘淑华 JIN Xin;WANG Nan;LIU Xiao-jing;ZHANG Hua;XUE Rui;ZHANG Jing;LIU Shu-hua(Department of Cardiac Rehabilitation,First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei,China)
出处 《心脏杂志》 CAS 2024年第6期670-675,共6页 Chinese Heart Journal
关键词 运动强度 射血分数 射血分数保留型心力衰竭 非狭窄冠状动脉 微循环阻力 exercise intensity ejection fraction heart failure with preserved ejection fraction nonnarrowed coronary arteries microcirculation resistance
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