A comparative study of two Nomograph risk factor predictive models of chronic heart failure with renal insufficiency
-
摘要:目的
基于Lasso-Logistic回归分析构建2种慢性心力衰竭患者合并肾功能不全的列线图风险预测模型并进行比较。
方法收集996例慢性心力衰竭患者的临床资料，按7∶3比例随机分为建模组698例与验证组298例。基于Lasso回归筛选变量，将差异具有统计学意义的变量纳入多因素Logistic回归分析筛选独立影响因素，对构建的2种列线图模型进行比较并评价临床有效性。
结果建模组698例患者中, 148例患者合并肾功能不全，占21.20%。模型1多因素Logistic回归分析结果显示，血红蛋白、肌酐、尿酸、年龄、瓣膜性心脏病、有无合并症是慢性心力衰竭患者合并肾功能不全的独立影响因素(P < 0.05); 模型2多因素Logistic回归分析结果显示，血红蛋白、肌酐、尿酸、有无合并症是慢性心力衰竭患者合并肾功能不全的独立影响因素(P < 0.05)。模型1的曲线下面积(AUC)为0.814, Hosmer-Lemeshow检验结果显示该模型未偏离完美拟合(P=0.08), 且校准图显示该模型具有较好的一致性; 模型2的AUC为0.806, Hosmer-Lemeshow检验结果显示该模型偏离完美拟合(P < 0.01), 且校准图显示该模型的一致性较差。验证组结果显示，模型1、模型2的AUC分别为0.835、0.824, Hosmer-Lemeshow检验结果显示模型均未偏离完美拟合(P=0.12、0.45), 且校准曲线显示一致性较好。
结论基于Lasso-Logistic回归分析构建的2个风险预测模型对慢性心力衰竭患者合并肾功能不全风险具有较好的预测能力，但模型1的区分度、Hosmer-Lemeshow检验结果和校准曲线一致性更佳，临床适用性更强，净收益更高，建议临床应用时选择模型1。
Abstract:ObjectiveTo construct two Nomograph risk factor predictive models for chronic heart failure patients with renal insufficiency based on Lasso-Logistic regression analysis and compare their efficacy.
MethodsThe clinical data of 996 patients with chronic heart failure were collected. These patients were randomly divided into modeling group(698 cases) and verification group(298 cases) in a ratio of 7∶3. Lasso regression was used to screen variables, multivariate Logistic regression was used to screen independent risk factors for variables with statistical significance, and two models were compared to the evaluate their clinical effectiveness.
ResultsOf 698 patients in the modeling group, 148(21.20%) were complicated with renal insufficiency. Multivariate Logistic regression results of model 1 showed that hemoglobin, creatinine, uric acid, age, valvular heart disease, and presence or absence of complication were independent risk influencing factors(P < 0.05). Multivariate Logistic regression results of model 2 showed that hemoglobin, creatinine, uric acid, and presence or absence of complication were independent influencing factors (P < 0.05). The area under the curve (AUC) of model 1 was 0.814, and Hosmer-Leishow test results showed that it did not deviate, and was perfectly matched (P=0.08), the calibration chart showed that the model has good consistency. The AUC of model 2 was 0.806. The results of Hosmer-Lemeshow showed that the model was deviated from the perfect fit (P < 0.01), and the calibration chart showed that the consistency of the model was poor. The results of the validation group showed that the AUCs of model 1 and model 2 were 0.835, 0.824, respectively. Hosmer Lemeshow test showed that the models did not deviate from the perfect fit (P=0.12, 0.45), and the calibration curve also had good consistency.
ConclusionThe two Nomograph risk factors predictive models based on Lasso-Logistic regression have better ability in predicting the risk of chronic heart failure patients with renal insufficiency, but model 1 has better differentiation, consistency beween Hosmer-Lemeshow test results and calibration curve, stronger clinical applicability and higher net benefit, so model 1 is recommended for clinical application.
-
-
表 1 建模组慢性心力衰竭患者的基线特征(x±s)[n(%)]
特征 分类 发生组(n=148) 未发生组(n=550) 性别 男 97(65.54) 330(60.00) 女 51(34.46) 220(40.00) 居住地区 城市 73(49.32) 254(46.18) 农村 75(50.68) 296(53.82) 冠心病 否 60(40.54) 223(40.55) 是 88(59.56) 327(59.45) 瓣膜性心脏病 否 97(65.54) 440(80.00) 是 51(34.46) 110(20.00) 心肌病 否 122(82.43) 445(80.91) 是 26(17.57) 105(19.09) 心律失常 否 120(81.08) 459(83.45) 是 28(18.92) 91(16.55) 吸烟史 否 85(57.43) 344(62.55) 是 63(42.57) 206(37.45) 酗酒史 否 105(70.95) 393(71.45) 是 43(29.05) 157(28.55) 合并症 无 3(2.03) 90(16.36) 有 145(97.97) 460(83.64) B型钠尿肽升高 否 4(2.70) 45(8.18) 是 144(97.30) 505(91.82) 年龄/岁 70.44±13.20 66.25±14.95 收缩压/mmHg 123.96±21.43 124.49±47.38 舒张压/mmHg 76.28±12.82 75.92±12.42 每搏量/mL 64.86±23.69 66.09±19.68 白细胞计数/(×109/L) 6.29±2.16 6.78±2.48 红细胞计数/(×1012/L) 3.92±0.73 4.22±0.64 血钠/(mmol/L) 138.78±5.46 139.43±3.74 血氯/(mmol/L) 100.70±5.52 101.48±6.18 肌酐/(μmol/L) 143.68±99.51 87.61±48.97 淋巴细胞百分比/% 22.49±11.32 24.35±9.44 血红蛋白/(g/L) 118.71±23.10 129.14±22.27 血钾/(mmol/L) 4.42±0.62 4.29±0.55 尿素/(mmol/L) 12.06±7.16 7.97±4.27 尿酸/(μmol/L) 458.51±162.30 376.34±136.81 
下载: 导出CSV
表 2 自变量赋值表
自变量 赋值 自变量 赋值 性别 男=0, 女=1 居住地区 城市=0, 农村=1 冠心病 否=0, 是=1 瓣膜性心脏病 否=0, 是=1 心肌病 否=0, 是=1 心律失常 否=0, 是=1 吸烟史 否=0, 是=1 酗酒史 否=0, 是=1 合并症程度 否=0, 是=1 BNP 否=0, 是=1
下载: 导出CSV
表 3 模型1、模型2的多因素Logistic回归分析结果
变量 模型1 模型2 SE OR(95%CI) P SE OR(95%CI) P 肌酐 0.002 1.01(1.00~1.01) < 0.001 0.002 1.01(1.01~1.02) < 0.001 尿酸 0 1.00(1.00~1.00) < 0.001 0.001 1.01(1.00~1.01) < 0.001 血红蛋白 0.004 1.00(0.98~1.00) 0.025 0.004 0.98(0.98~0.99) < 0.001 年龄 0.008 1.00(1.00~1.04) 0.019 — — — 有无合并症 0.612 7.17(2.71~32.38) < 0.001 0.612 7.22(2.56~30.49) < 0.001 瓣膜性心脏病 0.229 1.92(1.22~3.01) 0.004 — — —
下载: 导出CSV
-
[1] LAN T, LIAO Y H, ZHANG J, et al. Mortality and readmission rates after heart failure: a systematic review and meta-analysis[J]. Ther Clin Risk Manag, 2021, 17: 1307-1320. doi: 10.2147/TCRM.S340587
[2] LIM Y M F, ONG S M, KOUDSTAAL S, et al. Trends for readmission and mortality after heart failure hospitalisation in Malaysia, 2007 to 2016[J]. Glob Heart, 2022, 17(1): 20. doi: 10.5334/gh.1108
[3] EMMONS-BELL S, JOHNSON C, ROTH G. Prevalence, incidence and survival of heart failure: a systematic review[J]. Heart, 2022, 108(17): 1351-1360. doi: 10.1136/heartjnl-2021-320131
[4] LÖFMAN I, SZUMMER K, DAHLSTRÖM U, et al. Associations with and prognostic impact of chronic kidney disease in heart failure with preserved, mid-range, and reduced ejection fraction[J]. Eur J Heart Fail, 2017, 19(12): 1606-1614. doi: 10.1002/ejhf.821
[5] 中华人民共和国国务院. 中国防治慢性病中长期规划(2017—2025年)[J]. 中国实用乡村医生杂志, 2017, 24(11): 6-11. doi: 10.3969/j.issn.1672-7185.2017.11.002 [6] 郭艺芳. 2022年美国心力衰竭管理指南更新要点解读[J]. 中国全科医学, 2022, 25(17): 2051-2054. doi: 10.12114/j.issn.1007-9572.2022.0288 [7] NELSON R G, GRAMS M E, BALLEW S H, et al. Development of risk prediction equations for incident chronic kidney disease[J]. JAMA, 2019, 322(21): 2104-2114. doi: 10.1001/jama.2019.17379
[8] 澈乐木格, 邓龙廉, 赵建全. 预测早发冠心病的发生风险: 临床列线图的开发和评估[J]. 实用临床医药杂志, 2022, 26(24): 51-56. doi: 10.7619/jcmp.20222458 [9] 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 慢性心力衰竭基层诊疗指南(实践版·2019)[J]. 中华全科医师杂志, 2019, 18(10): 948-956. doi: 10.3760/cma.j.issn.1671-7368.2019.10.009 [10] TRIPOSKIADIS F, XANTHOPOULOS A, PARISSIS J, et al. Pathogenesis of chronic heart failure: cardiovascular aging, risk factors, comorbidities, and disease modifiers[J]. Heart Fail Rev, 2022, 27(1): 337-344. doi: 10.1007/s10741-020-09987-z
[11] CHA′ON U, TIPPAYAWAT P, SAE-UNG N, et al. High prevalence of chronic kidney disease and its related risk factors in rural areas of Northeast Thailand[J]. Sci Rep, 2022, 12(1): 18188. doi: 10.1038/s41598-022-22538-w
[12] 黄荔荔, 徐琴, 沈建宏, 等. 228例心力衰竭患者非计划再入院率调查及logistic预测模型建立研究[J]. 中国心血管病研究, 2022, 20(9): 811-816. doi: 10.3969/j.issn.1672-5301.2022.09.006 [13] 康元, 牛晓菁, 史秩菁, 等. 红细胞比容对老年女性心力衰竭患者3年不良结局事件的预测意义[J]. 中华老年心脑血管病杂志, 2022, 24(9): 908-911. doi: 10.3969/j.issn.1009-0126.2022.09.004 [14] 吴超, 赵雪燕, 袁晋青, 等. 心力衰竭患者NT-proANP、NT-proBNP和NT-proCNP与肾功能指标的相关性分析[J]. 南昌大学学报: 医学版, 2021, 61(2): 34-38, 67. https://www.cnki.com.cn/Article/CJFDTOTAL-JXYB202102007.htm [15] 徐玲玲, 周阳, 刘瑾, 等. 江苏省滨海县社区体检人群慢性肾功能不全的患病率及其相关因素调查[J]. 中华肾脏病杂志, 2022, 38(6): 520-527. doi: 10.3760/cma.j.cn441217-20211122-00072 [16] 孙磊, 李禄全, 杨晓慧. 基于决策曲线分析的临床预后重要影响因素研究[J]. 中国卫生统计, 2018, 35(6): 846-849. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT201806011.htm [17] 奚丽婧, 郭昭艳, 杨雪珂, 等. LASSO及其拓展方法在回归分析变量筛选中的应用[J]. 中华预防医学杂志, 2023, 57(1): 107-111. doi: 10.3760/cma.j.cn112150-20220117-00063 [18] CHANG H J, LIN K R, CHANG J L, et al. Risk factors for chronic kidney disease in older adults with hyperlipidemia and/or cardiovascular diseases in Taipei city, Taiwan: a community-based cross-sectional analysis[J]. Int J Environ Res Public Health, 2020, 17(23): 8763. doi: 10.3390/ijerph17238763
[19] 何珊, 关晓楠, 马桂伶, 等. 青年与中老年心力衰竭患者的临床特点及预后研究[J]. 中国临床医生杂志, 2023, 51(1): 24-27. doi: 10.3969/j.issn.2095-8552.2023.01.008 [20] 何文静. 血管紧张素抑制剂对心力衰竭合并肾性贫血患者肌酐和血红蛋白的影响[J]. 心脑血管病防治, 2019, 19(2): 153-155, 173. doi: 10.3969/j.issn.1009-816x.2019.02.015 [21] JANUS S E, HAJJARI J, CHAMI T, et al. Multi-variable biomarker approach in identifying incident heart failure in chronic kidney disease: results from the Chronic Renal Insufficiency Cohort study[J]. Eur J Heart Fail, 2022, 24(6): 988-995. doi: 10.1002/ejhf.2543
[22] HOEVELMANN J, MAHFOUD F, LAUDER L, et al. Valvular heart disease in patients with chronic kidney disease[J]. Herz, 2021, 46(3): 228-233. doi: 10.1007/s00059-020-05011-0
[23] TERNACLE J, CÔTÉ N, KRAPF L, et al. Chronic kidney disease and the pathophysiology of valvular heart disease[J]. Can J Cardiol, 2019, 35(9): 1195-1207. doi: 10.1016/j.cjca.2019.05.028
[24] 朱鹏程, 张倩, 卞金辉, 等. 二叶式主动脉瓣钙化关键基因的生物信息学分析[J]. 实用临床医药杂志, 2021, 25(9): 9-13, 17. doi: 10.7619/jcmp.20211339 [25] KAJIMOTO K, SATO N, TAKANO T. Relationship of renal insufficiency and clinical features or comorbidities with clinical outcome in patients hospitalised for acute heart failure syndromes[J]. Eur Heart J, 2017, 6(8): 697-708.
-
期刊类型引用(15)
1. 马治娥，赵文娟，王沛. 不同质子泵抑制剂对胃溃疡患者胃肠激素及氧化应激的影响. 贵州医药. 2024(01): 55-56 . 
百度学术
2. 孙敏. 四联疗法联合康复新液对消化性溃疡合并幽门螺杆菌感染患者的临床效果分析. 中国校医. 2024(01): 61-64 . 百度学术
3. 黄莉莉，黄晶晶. 奥美拉唑联合纤维蛋白粘合剂在消化性溃疡出血中的应用效果分析. 中国烧伤创疡杂志. 2024(03): 240-244 . 百度学术
4. 王燕，宋建国，李红，温爽，付琳璐. 雷尼替丁联合消化内镜对十二指肠溃疡的治疗效果. 中国医药指南. 2024(16): 86-89 . 百度学术
5. 刘雅红. 单用质子泵抑制剂治疗消化性溃疡对根除幽门螺杆菌的影响. 中国现代药物应用. 2024(14): 112-114 . 百度学术
6. 白玲，赵琴. 血清谷胱甘肽过氧化物酶、脂质过氧化物水平与妊娠期糖尿病及其糖脂代谢异常、胰岛素抵抗和母婴结局的关系. 安徽医药. 2024(11): 2226-2230 . 百度学术
7. 陈偲. 小组式知信行健康宣教在消化道溃疡患者中的应用. 江苏卫生事业管理. 2024(10): 1420-1422 . 百度学术
8. 王建东. 愈疡健脾方联合质子泵抑制剂治疗脾胃虚寒型消化性溃疡的临床观察. 基层医学论坛. 2024(36): 153-156 . 百度学术
9. 陈波，张庆团，黄克锋，杨燕芬，熊弋平. 瑞巴派特四联疗法对幽门螺杆菌阳性消化性溃疡患者血清氧化应激指标和胃蛋白酶原的影响. 现代生物医学进展. 2023(11): 2168-2172 . 百度学术
10. 黄小花. 健胃愈疡汤辅助四联疗法治疗十二指肠溃疡的效果及对溃疡面积、胃肠相关指标的影响. 临床合理用药. 2023(29): 81-84 . 百度学术
11. 俞洪韵，陈慧丽，朱锋，汪璇，陶治华. 健胃愈疡颗粒联合西咪替丁治疗重症患者应激性溃疡的临床研究. 现代药物与临床. 2023(10): 2506-2510 . 百度学术
12. 胡量. 康复新液治疗胃溃疡的临床疗效及对炎性因子、氧化应激和胃黏膜修复作用的影响分析. 现代诊断与治疗. 2023(17): 2543-2545+2556 . 百度学术
13. 陆文鹏，陈民，陈洁，郑新梅，董小耘. 基于生物信息学探讨败酱散调控氧化应激缓解克罗恩病的机制. 实用临床医药杂志. 2022(16): 11-17 . 本站查看
14. 黄以治. 胃黏膜保护剂联合质子泵抑制剂治疗消化性溃疡伴出血的临床效果. 中国医药指南. 2022(35): 29-32 . 百度学术
15. 张珊珊，刘畅，阴雨龙. 奥美拉唑与雷尼替丁治疗十二指肠溃疡的疗效对比分析. 中外医疗. 2022(31): 136-139 . 百度学术
其他类型引用(3)
计量
- 文章访问数:
- HTML全文浏览量:
- PDF下载量:
- 被引次数: 18
苏公网安备 32100302010246号