摘要
目的:分析血液透析患者发生心力衰竭的危险因素并构建列线图模型。方法:回顾性分析咸阳市中心医院2021年1月至2022年4月218例血液透析患者的临床资料。其中,发生心力衰竭83例(心力衰竭组),未发生心力衰竭135例(对照组)。记录患者的相关临床资料,包括年龄、性别、体质量指数、病程、是否并发感染、血钙、血磷、可溶性CD 146(sCD 146)、可溶性生长刺激表达基因2蛋白(sST2)、N末端脑钠肽前体(NT-proBNP)、时间平均尿素浓度(TACurea)、肿瘤坏死因子α(TNF-α)、血肌酐和24 h尿量。绘制受试者工作特征(ROC)曲线,分析各指标评估血液透析患者发生心力衰竭的效能。采用多因素Logistic回归分析影响血液透析患者发生心力衰竭的独立危险因素。采用R语言软件4.0"rms"包构建预测血液透析患者发生心力衰竭的列线图模型,校正曲线对列线图模型进行内部验证,决策曲线对列线图模型的预测效能进行评估。结果:两组性别构成、年龄、体质量指数、病程、24 h尿量和血肌酐比较差异无统计学意义(P>0.05);心力衰竭组并发感染率、血磷、sCD 146、sST2、NT-proBNP、TNF-α和TACurea明显高于对照组[39.76%(33/83)比8.89%(12/135)、(1.53±0.34)mmol/L比(1.27±0.24)mmol/L、(43.60±10.24)μmol/L比(28.08±7.99)μmol/L、(49.00±9.41)μg/L比(34.53±8.05)μg/L、(38.57±6.79)μg/L比(29.72±5.64)μg/L、(5.18±0.92)μg/L比(4.07±1.13)μg/L和(24.28±4.37)mmol/L比(17.96±2.52)mmol/L],血钙明显低于对照组[(1.95±0.36)mmol/L比(2.31±0.39)mmol/L],差异有统计学意义(P<0.01)。ROC曲线分析结果显示,血钙、血磷、sCD 146、sST2、NT-proBNP、TNF-α、TACurea评估血液透析患者发生心力衰竭的最佳截断值分别为2.01 mmol/L、1.42 mmol/L、34.15μmol/L、40.37μg/L、35.37μg/L、4.33μg/L和20.74 mmol/L。多因素Logistic回归分析结果显示,血钙(≤2.01 mmol/L)、血磷(>1.42 mmol/L)、sCD 146(>34.15μmol/L)、sST2(>40.37μg/L)�
Objective To analyze the risk factors for heart failure in patients with hemodialysis,and to construct a nomogram model.Methods The clinical data of 218 patients with hemodialysis in Xianyang Central Hospital from January 2021 to April 2022 were retrospectively analyzed.Among them,83 cases developed heart failure(heart failure group),and 135 cases did not develop heart failure(control group).The relevant clinical data were recorded,including age,sex,body mass index,disease duration,concurrent infection,blood calcium,blood phosphorus,soluble CD146(sCD146),soluble growth-stimulated expression gene 2 protein(sST2),N-terminal brain natriuretic peptide precursor(NT-proBNP),time-averaged urea concentration(TACurea),tumor necrosis factorα(TNF-α),blood creatinine and 24 h urine volume.Receiver operating characteristic(ROC)curve was used to analyze the efficacy of each index in predicting heart failure in patients with hemodialysis.Multivariate Logistic regression was used to analyze the independent risk factors of heart failure in patients with hemodialysis.R language software 4.0"rms"package was used to construct the nomogram model for predicting the heart failure in patients with hemodialysis,the calibration curve was internally validated,and the decision curve was used to evaluate the predictive efficacy of the nomogram model.Results There were no statistical difference in gender composition,age,body mass index,disease duration,24 h urine volume and blood creatinine between the two groups(P>0.05);the rate of concurrent infection,blood phosphorus,sCD146,sST2,NT-proBNP,TNF-αand TACurea in heart failure group were significantly higher than those in control group:39.76%(33/83)vs.8.89%(12/135),(1.53±0.34)mmol/L vs.(1.27±0.24)mmol/L,(43.60±10.24)μmol/L vs.(28.08±7.99)μmol/L,(49.00±9.41)μg/L vs.(34.53±8.05)μg/L,(38.57±6.79)μg/L vs.(29.72±5.64)μg/L,(5.18±0.92)μg/L vs.(4.07±1.13)μg/L and(24.28±4.37)mmol/L vs.(17.96±2.52)mmol/L,the blood calcium was significantly lower than that in control group:(1.95±0.
作者
唐莉
田敏
乔西民
曹李娜
王萍
Tang Li;Tian Min;Qiao Ximin;Cao Lina;Wang Ping(Department of Nephrology and Rheumatology and Immunology,Xianyang Central Hospital,Xianyang 712000,China;Department of Urology,Xianyang Central Hospital,Xianyang 712000,China;Department of Hemodialysis,Xianyang Central Hospital,Xianyang 712000,China)
出处
《中国医师进修杂志》
2023年第7期651-657,共7页
Chinese Journal of Postgraduates of Medicine
基金
陕西省卫生健康科研基金项目(2021A003)。
关键词
透析
心力衰竭
危险因素
列线图
Dialysis
Heart failure
Risk factors
Nomograms
