摘要
目的探究扩张型心肌病(DCM)患者心内血栓形成的危险因素,基于此构建列线图预测模型并进行验证及评价。方法该研究纳入诊断为DCM的88例合并心内血栓患者和544例无心内血栓患者,并将研究对象按7∶3比例随机分为训练集和验证集。通过单因素及多因素Logistic回归分析筛选出DCM患者心内血栓形成的独立危险因素,借助R软件构建列线图预测模型。应用受试者工作特征曲线(ROC)、Hosmer-Lemeshow拟合优度检验和校准曲线、决策曲线对模型进行验证及评价。结果二元Logistic回归分析显示:年龄、心房颤动(房颤)、左心室舒张末内径(LVEDD)、脑钠肽(BNP)和β受体阻滞剂与DCM患者心内血栓形成独立相关。基于此5项因素构建列线图预测模型并进行验证,结果显示训练集和验证集的ROC曲线下面积分别为0.823(95%CI:0.760~0.887)、0.803(95%CI:0.705~0.901),表明模型具有良好的鉴别能力;校准曲线的Hosmer-Lemeshow检验结果分别为^(χ2)=6.679、P=0.572和^(χ2)=2.588、P=0.958,显示预测结果与实际结果具有良好的一致性;决策曲线显示阈值在0.05~0.92区间内,临床净获益较高。结论基于年龄、房颤、LVEDD、BNP和β受体阻滞剂5项因素构建的列线图预测模型,具有良好的鉴别能力、校准能力和临床获益,能有效指导临床医师进行早期危险因素干预,降低心内血栓发生的风险。
Objective To explore the risk factors for intracardiac thrombosis in dilated cardiomyopathy(DCM)patients and to construct,validate,and evaluate a nomogram prediction model based on these factors.Methods 88 patients diagnosed with DCM and complicated with intracardiac thrombus,and 544 patients without intracardiac thrombus were included.The participants were randomly divided into training and validation sets at a ratio of 7∶3.Using both univariate and multivariate Logistic regression analyses,independent risk factors for intracardiac thrombosis in DCM patients were identified.A nomogram prediction model was constructed using R software.The model’s validity and performance were assessed using the receiver operating characteristic(ROC)curve,the Hosmer-Lemeshow goodness-of-fit test,calibration curve,and decision curve.Results The binary Logistic regression analysis showed that age,atrial fibrillation,left ventricular end-diastolic diameter(LVEDD),brain natriuretic peptide(BNP),andβ-blockers were independently associated with intracardiac thrombosis in DCM patients.Based on these five factors,a nomogram was constructed and validated.The area under the ROC curve for the training set was 0.823(95%CI:0.760~0.887)and 0.803(95%CI:0.705~0.901)for the validation set,indicating a good discriminative ability.The Hosmer-Lemeshow test results for the calibration curve were(^(χ2)=6.679,P=0.572)for the training set and(^(χ2)=2.588,P=0.958)for the validation set,indicating a good fit between predicted and observed outcomes.The decision curve showed a high net clinical benefit in the threshold range of 0.05~0.92.Conclusion Based on age,atrial fibrillation,LVEDD,BNP,andβ-blockers,the nomogram prediction model exhibits good discriminative and calibration abilities,and high clinical benefit.It can effectively guide clinicians in early intervention of risk factors,reducing the risk of intracardiac thrombosis in DCM patients.
作者
李军
胡泽平
朱学涛
Li Jun;Hu Zeping;Zhu Xuetao(Dept of Cardiology,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
2024年第4期708-714,共7页
Acta Universitatis Medicinalis Anhui
基金
安徽高校自然科学研究项目(编号:KJ2019ZD65)
安徽省自然科学基金(编号:2208085MH200)。
关键词
扩张型心肌病
心内血栓
列线图
危险因素
左心室舒张末内径
脑钠肽
Β受体阻滞剂
dilated cardiomyopathy
intracardiac thrombosis
nomogram
risk factors
left ventricular end-diastolic diameter
brain natriuretic peptide
β-blockers
