摘要
目的 基于新疆冠心病证候特点,构建并验证冠心病患者发生主要心血管不良事件(Major adverse cardiac events, MACE)的临床预测模型。方法 回顾性分析2016年1月至2021年1月新疆医科大学附属中医医院接诊的624例冠心病患者,均有明确的冠状动脉造影诊断。将患者按照8∶2的比例,分为训练集和验证集,各集根据过去1年内MACE发生的情况,分为MACE组和非MACE组。采用单因素分析、最小绝对收缩选择算子(Least absolute shrinkage and selection operator, LASSO)、多因素Logistic回归分析筛选冠心病患者发生MACE的影响因素并建立临床预测模型,通过Hosmer-Lemeshow检验评价模型拟合优度,采用受试者工作特征(Receiver operating characteristic,ROC)曲线下面积(Area under curve,AUC)、校准曲线、决策曲线分析评估模型的临床预测效能。结果 LASSO回归分析筛选出年龄、性别、吸烟史、心血管病家族史、糖尿病史、甘油三酯异常、低密度脂蛋白胆固醇异常、高密度脂蛋白胆固醇异常、空腹血糖异常、血肌酐异常以及西北燥证兼血瘀证共11个变量为影响结局的因素;单因素回归分析结果显示,合并吸烟史、糖尿病史、心血管病家族史、西北燥证兼血瘀证、甘油三酯异常是冠心病患者发生MACE的危险因素(OR>1且P<0.05);多因素Logistic回归分析结果显示,心血管病家族史、西北燥证兼血瘀证为独立危险因素;Hosmer-Lemeshow检验结果显示,训练集(χ^(2)=18.163,P>0.05)、验证集(χ^(2)=7.469,P>0.05),表明模型预测结果与观测数据差异无统计学意义;训练集与验证集AUC分别为0.796和0.708;决策曲线显示该模型可使冠心病患者临床获益。结论 基于新疆特殊地域环境下冠心病证候特点构建的临床预测模型具有良好的临床实用价值,可早期识别新疆冠心病患者发生MACE风险,为制定相应的防控MACE措施提供参考依据。
Objective Based on the characteristics of coronary heart disease syndromes(CHD)in Xinjiang,a clinical prediction model for major adverse cardiovascular events(MACE)was constructed and verified.Methods A retrospective analysis of 624 patients with CHD admitted to the hospital from January 2016 to January 2021,all of whom had a clear diagnosis of coronary angiography.All patient data were divided into the training set and the verification set in an 8∶2 ratio.Each set was divided into the MACE group and the non-MACE group(Non-MACE)based on the occurrence of MACE in the past year.Univariate analysis,Least Absolute Shrinkage and Selection Operator(LASSO),and multivariate Logistic regression analysis were used to screen predictors of MACE in patients with coronary heart disease and establish a clinical predictive model.Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model.Area under the Receiver Operating Characteristics(ROC)curve,calibration curve,and decision curve were used to analyze and evaluate the clinical predictive power of the model.Results LASSO regression analysis screened out a total of 11 variables as factors affecting the outcome:age,gender,smoking history,family history of cardiovascular disease,diabetes history,abnormal triglycerides,abnormal low-density lipoprotein cholesterol,abnormal fasting blood glucose,abnormal blood creatinine,and nNorthwest dryness syndrome combined with blood stasis syndrome.Univariate regression analysis showed that combined smoking history,diabetes history,family history of cardiovascular disease,northwest dryness syndrome combined with blood stasis syndrome,and abnormal triglycerides were the adverse influencing factors for MACE in patients with CHD coronary heart disease(OR>1 and P<0.05);Multivariate Logistic regression analysis showed that family history of cardiovascular disease,northwest dryness syndrome and blood stasis syndrome were independent influencing factors.After Hosmer-Lemeshow test of the training set(χ^(2)=18.163,P>0.05)and the verification set(χ^(2)=7.469,P>0.05),there was no significant difference between the model prediction results and the observed data.The areas under the ROC curve for the training set and verification set were 0.796 and 0.708,respectively;the decision curve showed that the model could provide clinical benefits for the patients with CHD coronary heart disease.Conclusion This study demonstrates that the clinical prediction model,constructed based on the characteristics of CHD coronary heart disease(CHD)syndromes in the unique geographical environment of Xinjiang,has strong clinical utility.It can early identify the risk of major adverse cardiovascular events(MACE)in Xinjiang CHD patients and provide a reference for formulating targeted prevention and control measures.
作者
李欣彤
李鹏
付长庚
龙霖梓
周靖雅
朱忠帅
LI Xintong;LI Peng;FU Changgeng;LONG Linzi;ZHOU Jingya;ZHU Zhongshuai(The fourth Clinical Medical College of Xinjiang Medical University,Urumqi 830099,China;Department of Cardiology I,TCM Hospital Affiliated to Xinjiang Medical University,Urumqi 830000,China;Department of Cardiology,China Academy of Chinese Medical Sciences,Beijing 100091,China;Department of Geriatrics,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China)
出处
《新疆医科大学学报》
2025年第5期682-690,共9页
Journal of Xinjiang Medical University
基金
新疆维吾尔自治区区域协同创新专项(科技援疆计划)(2022E02114)
省部共建中亚高发病成因与防治国家重点实验室开放课题项目(SKL-HIDCA-2021-ZY6)。
关键词
冠心病
预测模型
西北燥证
血瘀证
主要不良心血管事件
coronary heart disease(CHD)
predictive model
northwest dryness syndrome
blood stasis syndrome
major adverse cardiovascular events
