摘要
目的探讨H型高血压患者不良心血管事件(MACE)发生的危险因素,并构建H型高血压患者MACE发生风险预测模型。方法选取2019年1月至2022年11月该院收治的375例H型高血压患者作为研究对象,根据是否发生MACE分为MACE组(41例)和非MACE组(334例)。收集两组临床资料,采用多因素Logistic回归分析H型高血压患者发生MACE的危险因素。构建H型高血压患者MACE发生风险的列线图预测模型,以C-index量化模型预测性能,并绘制校准曲线评价列线图预测模型的校准度及鉴别效度,绘制决策曲线分析列线图预测模型的临床净受益。结果MACE组高血压病程、同型半胱氨酸(Hcy)、尿酸(UA)、Toll样受体(TLR4)水平及靶器官损害数目>2个的患者比例、高血压分级为3级的患者比例、入院当日收缩压(SBP)、入院当日舒张压(DBP)、夜间平均SBP、夜间平均DBP均高于非MACE组,高分子量脂联素(HMW-ADP)水平低于非MACE组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,夜间平均SBP、Hcy、TLR4水平升高及HMW-ADP水平降低均是H型高血压患者发生MACE的危险因素(P<0.05)。列线图预测模型预测H型高血压患者MACE发生风险的C-index为0.821(95%CI:0.712~0.896)。决策曲线分析结果显示,当列线图预测模型预测值为0.75~0.80时,可提供附加临床获益。结论基于Hcy、TLR4、HMW-ADP、夜间平均SBP构建H型高血压患者MACE发生风险的列线图预测模型具有良好预测效果,适合在临床工作中推广应用。
Objective To investigate the risk factors of adverse cardiovascular events(MACE)in patients with H-type hypertension and to construct a risk prediction model for MACE in patients with H-type hypertension.Methods A total of 375 patients with H-type hypertension admitted to the hospital from January 2019 to November 2022 were selected as the research objects.According to the occurrence of MACE,they were divided into MACE group(41 cases)and non-MACE group(334 cases).The clinical data of the two groups were collected,and the risk factors of MACE in patients with H-type hypertension were analyzed by multivariate Logistic regression.A nomogram prediction model for the risk of MACE in patients with H-type hypertension was constructed,and the predictive performance of the model was quantified by C-index.The calibration curve was drawn to evaluate the calibration and discriminant validity of the nomogram prediction model,and the decision curve was drawn to analyze the net clinical benefit of the nomogram prediction model.Results The course of hypertension,the levels of homocysteine(Hcy),uric acid(UA),Toll-like receptor(TLR4),the proportion of patients with more than 2 target organ damage,the proportion of patients with hypertension grade 3,the systolic blood pressure(SBP)on admission,the diastolic blood pressure(DBP)on admission,the average SBP at night and the average DBP at night in the MACE group were higher than those in the non-MACE group,and the level of high molecular weight adiponectin(HMW-ADP)in MACE group was lower than that in non-MACE group,and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that increased average SBP at night,Hcy,TLR4 levels and decreased HMW-ADP level were risk factors for MACE in patients with H-type hypertension(P<0.05).The C-index of the nomogram prediction model for the risk of MACE in patients with H-type hypertension was 0.821(95%CI:0.712-0.896).The results of decision curve analysis showed that when the predictive value of the nomogram prediction model was 0.75-0.80,it could provide additional clinical benefits.Conclusion The nomogram prediction model for MACE in patients with H-type hypertension based on Hcy,TLR4,HMW-ADP and average SBP at night has a good predictive effect and is suitable for clinical application.
作者
李琪
闫肃
唐瑞双
LI Qi;YAN Su;TANG Ruishuang(Department of Cardiology,the Third Hospital of Tangshan,Tangshan,Hebei 063000,China)
出处
《检验医学与临床》
CAS
2024年第11期1636-1639,1645,共5页
Laboratory Medicine and Clinic
关键词
高血压
靶器官损害
短期预后
危险因素
列线图
预防措施
hypertension
target organ damage
short-term prognosis
risk factor
nomogram
preventive measure
作者简介
李琪,女,主管护师,主要从事心内科方向的研究。
