摘要
目的:研究原发性扩张型心肌病(DCM)患者左心室逆重构(LVRR)的影响因素,并构建独立预测模型供临床参考。方法:回顾性分析收治的156例DCM患者,收集其临床资料,包括基本信息、临床特征、用药情况、影像学和心电图参数及生物标志物等。根据治疗6个月后的随访结果,将患者分为LVRR组(74例)和非LVRR组(82例)。对比两组临床资料,针对具有统计学意义的各项指标,进一步实施多因素Logistic回归分析,确定LVRR的独立预测因素,并构建预测模型,利用受试者工作特征(ROC)曲线下面积(AUC)评估其预测效能。结果:LVRR组的病程短于非LVRR组,DCM家族史比例、左束支传导阻滞(LBBB)比例、首次左心室舒张末期内径(LVEDD)、末次LVEDD、心率均低于非LVRR组,首次LVEDD<65 mm比例、首次左心室射血分数(LVEF)、首次LVEF>35%比例、末次LVEF均高于非LVRR组(均P<0.05);多因素Logistic回归分析显示,无LBBB(OR=0.754,95%CI:0.623~0.872,P<0.001)、首次LVEDD<65 mm(OR=1.014,95%CI:1.121~5.962,P<0.001)、首次LVEF>35%(OR=1.364,95%CI:1.137~5.449,P<0.001)为DCM患者发生LVRR的独立预测因素;预测模型验证显示模型有效且拟合良好(P<0.05);ROC曲线分析显示AUC为0.902(95%CI:0.856~0.949),当cut-off值为0.671时,敏感度为87.80%,特异度为79.30%(均P<0.05)。结论:无LBBB、首次LVEDD<65 mm、首次LVEF>35%是影响原发性扩张型心肌病左心室逆重构的独立预测因素,基于此构建的预测模型具有较高的预测价值。
Objective:To investigate the influencing factors of left ventricular reverse remodeling(LVRR)in patients with idiopathic dilated cardiomyopathy(DCM),and to establish an independent predictive model for LVRR.Methods:A retrospective analysis was conducted on 156 patients with DCM admitted.Their clinical data were collected,including basic information,clinical characteristics,medication use,imaging and electrocardiogram parameters,and biomarkers,etc.According to the follow-up results after 6 months of treatment,the patients were divided into LVRR group(74 cases)and non-LVRR group(82 cases).The clinical data of the two groups were compared,and multivariate Logistic regression analysis was performed to determine the independent predictors of LVRR for statistically significant indicators,and a predictive model was constructed.The area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the predictive efficacy.Results:The course of disease in LVRR group was shorter than that in non-LVRR group.The proportion of DCM family history,LBBB,first LVEDD,last LVEDD and heart rate in LVRR group were lower than those in non-LVRR group.The proportion of LVEDD<65 mm at the first time,LVEF at the first time,LVEF>35%at the first time,and LVEF at the last time were higher in the LVRR group than in the non-LVRR group(all P<0.05).Multivariate Logistic regression analysis showed that no LBBB(OR=0.754,95%CI:0.623-0.872,P<0.001),LVEDD<65 mm at the first time(OR=1.014,95%CI:1.121-5.962,P<0.001)and first LVEF>35%(OR=1.364,95%CI:1.137-5.449,P<0.001)were independent predictors of LVRR in DCM patients.The validation of the prediction model showed that the model was effective and fitted well(P<0.05).ROC curve analysis showed that the AUC was 0.902(95%CI:0.856-0.949),when the cut-off value was 0.671,the sensitivity was 87.80%,and the specificity was 79.30%(all P<0.05).Conclusion:Absence of LBBB,initial LVEDD<65 mm,and initial LVEF>35%are independent predictors of left ventricular reverse remodeling in patients with idiopathic dilated cardiomyopathy,and the prediction model based on these factors has high predictive value.
作者
解晓媛
高蕾
郝六一
薛萱
XIE Xiaoyuan;GAO Lei;HAO Liuyi;XUE Xuan(Department of Cardiology,Yuncheng Central Hospital,Shanxi Medical University,Yuncheng 044000,China)
出处
《陕西医学杂志》
2025年第10期1365-1369,共5页
Shaanxi Medical Journal
基金
山西省重点研发计划项目(DZHG202416231)。
关键词
原发性扩张型心肌病
左心室逆重构
独立预测模型
影响因素
预测价值
Primary dilated cardiomyopathy
Left ventricular reverse remodeling
Independent predictive model
Influencing factors
Predictive value
