摘要
目的分析冠状动脉粥样硬化(CAS)的危险因素,并联合血液学指标和颈动脉斑块构建列线图模型,进一步预测CAS发生的风险。方法选取安徽医科大学第一附属医院147例疑似冠状动脉硬化性心脏病患者,依据冠状动脉CT血管造影(CTA)的结果分为非CAS组50例和CAS组97例。彩超测定患者颈动脉内-中膜厚度(cIMT)和斑块,收集患者的血常规、生化及止凝血结果。采用单因素分析和多因素Logistic回归分析筛选CAS的独立危险因素,并基于这些独立危险因素构建列线图风险预测模型,最后绘制ROC曲线。结果非CAS组和CAS组患者年龄、性别、吸烟史和高血压病等方面有分布差异,CAS组患者红细胞分布宽度-SD值(RDW-SD)、胱抑素C、肌酐、空腹血糖、中性粒细胞/淋巴细胞比率(NLR)、颈动脉斑块发生率及cIMT较非CAS组患者明显升高,淋巴细胞计数较非CAS组患者降低(P<0.05)。多因素二元Logistic回归分析发现男性、有颈动脉斑块、RDW-SD升高、空腹血糖升高及淋巴细胞计数降低是CAS发生的独立危险因素(P<0.05)。基于上述5项指标构建了列线图预测CAS发生的风险,列线图的总分数可以高效预测患者发生CAS的风险(AUC:0.870,95%CI:0.805~0.936,Hosmer-Lemeshow P=0.553)。结论该研究建立了一种预测CAS发生风险的新型列线图,通过分析患者相关血液学指标和颈动脉斑块的情况,可以较为准确预测患者CAS发生的风险,为临床诊疗提供指导。
Objective To analyze the risk factors of coronary atherosclerosis(CAS),and combine hematological indicators and carotid artery plaque to form a new nomogram model to further predict the risk of CAS.Methods This study is a retrospective case-control study.147 patients with suspected coronary artery disease(CAD)were selected from the First Affiliated Hospital of Anhui Medical University.Based on the results of coronary CT angiography(coronary CTA),they were divided into non-CAS group(50 cases)and CAS group(97 cases).Color Dopplerultrasound was used to measure the carotid artery intima-media thickness(cIMT)and plaque,and the results of blood routine test,basic blood chemistry test and coagulation test were collected.Nomogram was used to enstablish the prediction model,and the prognostic value was validated by ROC curve.Results There were differences of age,gender,smoking history and hypertension between the non-CAS group and the CAS group.The red blood cell distribution width-SD value(RDW-SD)of the CAS group,cystatin C,creatinine,fasting plasma glucose,the neutrophil/lymphocyte ratio(NLR),carotid plaque,and cIMT in CAS group were significantly higher than those in the non-CAS group,and the lymphocyte in CAS group was lower than that in non-CAS group(P<0.05).Multivariate binary logistic regression analysis found that the factors of men,carotid plaque,elevated RDW-SD,elevated fasting plasma glucose and decreased lymphocyte count were independent risk factors for the occurrence of CAS(P<0.05).Based on the above five indicators,a new nomogram was generated to predict the risk of CAS.The total points of the new nomogram could effectively predict the risk of CAS(AUC:0.870,95%CI:0.805-0.936,Hosmer-Lemeshow P=0.553).Conclusion This study established a new type of nomogram to predict the risk of CAS.By analyzing the patients′hematological indicators and carotid plaque,the risk of CAS can be accurately predicted to provide guidance for clinical diagnosis and treatment.
作者
叶蕊蕊
李洁华
Ye Ruirui;Li Jiehua(Dept of General Practice,The First Affiliated Hospital of Anhui Medical University,Hefei 230022)
出处
《安徽医科大学学报》
CAS
北大核心
2021年第9期1464-1469,共6页
Acta Universitatis Medicinalis Anhui
基金
安徽省重点研究和开发计划项目(编号:201904a07020041)。
