摘要
目的:创建并验证心脏再同步化治疗(CRT)患者临床预后的风险评分系统。方法:连续纳入2010-01至2015-12于我院首次接受CRT的患者367例。随访终点事件为全因死亡(包括心脏移植)和心力衰竭再住院。随机选取300例患者为建模组构建风险评分系统,其余67例为验证组进行验证。采用Cox风险比例回归模型建立评分系统;受试者工作特征(ROC)曲线下面积(AUC)评价并对比HEAL评分与EARRN评分的区分度;Hosmer-Lemeshow法评价拟合优度;Kaplan-Meier法比较不同评分患者的临床终点。结果:建模组分析显示,高敏C反应蛋白(HR=1.137,95%CI:1.072~1.205,P<0.001)、大内皮素-1(HR=1.934,95%CI:1.066~3.507,P=0.03)、左心房前后径(HR=1.045,95%CI:1.007~1.084,P=0.02)、纽约心脏协会(NYHA)心功能Ⅳ级(HR=2.583,95%CI:1.331~5.013,P=0.005)是CRT患者不良预后的独立危险因素。依据危险因素β偏回归系数建立HEAL评分,根据分值划定患者危险分级:<4分为低危,4~10分为中危,>10分为高危。低、中、高危分级在建模组和验证组的ROC曲线下面积分别为0.719(95%CI:0.629~0.809)和0.708(95%CI:0.539~0.878),该评分可良好地区分不同危险分级患者的临床预后(Log-rank检验,建模组P<0.001,验证组P=0.002)。Hosmer-Lemeshow拟合优度较好(P=0.952)。对367例患者分别采用HEAL评分与EARRN评分,发现HEAL评分(AUC:0.763,95%CI:0.692~0.833)较EARRN评分(AUC:0.602,95%CI:0.517~0.687)区分度更高。结论:HEAL评分能有效地预测CRT患者不良预后,区分度优于EARRN评分,对于识别高危患者具有临床实践价值。
Objective： To create and validate a scoring system for predicting clinical prognosis in patients with cardiac resynchronization therapy（CRT）.Methods： A cohort of 367 consecutive patients received CRT in our hospital from 2010-01 to 2015-12 were enrolled. The endpoint follow-up events were all-cause death including heart transplantation and heart failure re-admission. The patients were randomly categorized into 2 groups： Modeling group, to develop HEAL scoring system, n=300 and Verification group, to validate HEAL model, n =67. HEAL system was established by Cox proportional hazards regression model, discrimination between HEAL and EARRN scoring systems was evaluated by AUC of ROC, HEAL calibration was assessed by Hosmer-Lemeshow test and clinical endpoint evaluation by 2 scoring systems were compared by Kaplan-Meier method. Results： Modeling group analysis indicated that hs-CRP（HR=1.137, 95% CI 1.072-1.205, P〈0.001）, big endothelin-1（HR=1.934, 95% CI 1.066-3.507, P =0.03）, left atrial diameter（HR=1.045, 95% CI 1.007-1.084, P =0.02） and NYHA IV（HR=2.583, 95% CI 1.331-5.013, P=0.005） were the independent risk factors of adverse prognosis in CRT patients. Based on β partial regression coefficient, HEAL scoring system was established to classify the patient＇s risk levels： low risk4, moderate risk 4-10 and high risk10. AUC for risk classification in Modeling group and Verification group were 0.719（95% CI 0.629-0.809） and 0.708（95% CI 0.539-0.878）, HEAL can well distinguish clinical prognosis in patients at different risk levels（log-rank test showed in Modeling group P〈0.001 and in Verification group P=0.002）; Hosmer-Lemeshow test presented good calibration, P=0.952. All 367 patients were respectively evaluated by HEAL and EARRN scoring systems, HEAL had the better discrimination than EARRN as AUC 0.763（95% CI 0.692-0.833） vs AUC 0.602（95% CI 0.517-0.687）.Conclusion： HEAL scoring system can effectively predict adverse prognosis in CRT patients, it had the bette
出处
《中国循环杂志》
CSCD
北大核心
2017年第8期761-765,共5页
Chinese Circulation Journal
关键词
心脏再同步治疗
危险性评估
预后
Cardiac resynchronization therapy
Risk assessment
Prognosis
