摘要
背景绝经后女性高血压患者是冠心病易发人群,其冠心病患病率与死亡率较绝经前显著升高。本研究在团队前期研究基础上进一步联合糖脂代谢、血管弹性等相关指标诊断绝经后女性高血压患者发生冠心病,以期为临床识别绝经后女性高血压患者的冠心病风险提供新思路。目的探讨三酰甘油葡萄糖(TyG)指数、踝肱指数(ABI)、臂踝脉搏波传导速度(baPWV)、脉压指数(PPI)、动脉硬化指数(AI)联合与绝经后女性高血压患者发生冠心病的相关性及预测价值,构建绝经后女性高血压患者冠心病发生风险的预测模型。方法本研究选取2019—2022年就诊于中日友好医院中西医结合心内科的首次行冠状动脉造影检查的绝经后女性高血压患者,根据冠状动脉造影结果分为冠心病组与非冠心病组。收集患者入院时的TyG指数、ABI、baPWV、PPI、AI等临床资料,采用多因素Logistic回归分析构建绝经后女性高血压患者冠心病发生风险预测模型,并绘制列线图实现模型可视化。采用受试者工作特征(ROC)曲线、校准曲线、临床决策曲线分析(DCA)评价诊断效能。结果本研究共纳入首次行冠状动脉造影的绝经后女性高血压患者300例,其中非冠心病组141例、冠心病组159例。多因素Logistic回归分析结果显示,ABI、baPWV、TyG指数、PPI、AI是绝经后女性高血压患者发生冠心病的影响因素(P<0.05),并根据预测方程绘制列线图。ROC曲线分析结果显示,ABI、baPWV、TyG指数、PPI、AI和联合预测模型预测绝经后女性高血压患者发生冠心病的ROC曲线下面积(AUC)分别为0.662、0.687、0.659、0.700、0.612、0.808(P<0.001),预测模型预测绝经后女性高血压患者冠心病发生风险的灵敏度为0.7806,特异度为0.7410。校准曲线显示预测结果与实际结果具有较好的一致性。DCA曲线表明列线图具有较好的临床实用价值。结论ABI、baPWV、TyG指数、PPI、AI是绝经后女性高血压患者发生冠心病的影响因素,新开发模型可对冠心病风险进行有效预警。
Background Postmenopausal women with hypertension are susceptible to coronary heart disease(CHD),and their prevalence and mortality of CHD are significantly higher than those before menopause.Based on the team's previous research,this study further combined with glucose and lipid metabolism,vascular elasticity and other related indicators to diagnose CHD in postmenopausal women with hypertension,in order to provide new ideas for clinical identification of CHD risk in postmenopausal women with hypertension.Objective To explore the correlation and predictive value of triglyceride glucose(TyG)index,ankle-brachial index(ABI),brachial-ankle pulse wave velocity(baPWV),pulse pressure index(PPI)and arteriosclerosis index(AI)in postmenopausal women with hypertension.Methods From January 2019 to December 2022,this study selected postmenopausal women with hypertension who underwent coronary angiography for the first time in the Department of Integrative Cardiology of China-Japan Friendship Hospital,and divided them into CHD group and non-CHD group according to the results of coronary angiography.The clinical data such as TyG index,ABI,baPWV,PPI,AI were collected at the time of admission.Multivariate Logistic regression analysis was used to construct a CHD risk prediction model for postmenopausal women with hypertension,and a nomogram was drawn.Calibration curve,receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate the diagnostic efficiency.Results In this study,300 postmenopausal women with hypertension who underwent coronary angiography for the first time were included,including 141 cases in non-CHD group and 159 cases in CHD group.Multivariate Logistic regression analysis showed that ABI,baPWV,TyG index,PPI and AI were the influencing factors of CHD in postmenopausal women with hypertension(P<0.05),and a nomogram was drawn according to which.The ROC curve analysis results showed that area under the curve(AUC)for ABI,baPWV,TyG index,PPI,AI and joint predictive model were 0.662,0.687,0.659,0.700,0.612 and 0.808,the sensitivity and specificity of the predictive model were 0.7806 and 0.7410,respectively.The calibration curve showed that the predicted results were in good agreement with the actual results.The decision curve analysis showed that the nomogram has good clinical value.Conclusion ABI,baPWV,TyG index,PPI and AI are independent influencing factors for the occurrence of CHD in postmenopausal women with hypertension.The newly developed model can better predict the risk of CHD.
作者
张高钰
王子涵
高雪菲
张瑾
代天顾
何清
樊佳溶
黄力
李琳
ZHANG Gaoyu;WANG Zihan;GAO Xuefei;ZHANG Jin;DAI Tiangu;HE Qing;FAN Jiarong;HUANG Li;LI Lin(Beijing University of Chinese Medicine,Beijing 100029,China;Department of Integrative Cardiology,China-Japan Friendship Hospital,Beijing 100029,China)
出处
《中国全科医学》
CAS
北大核心
2025年第1期39-46,共8页
Chinese General Practice
基金
中央高水平医院临床科研业务费资助—中日友好医院“菁英计划”人才培育工程(ZRJY2021-TD03)
北京市自然科学基金资助(7232320)
北京中医药大学教育科学研究课题(XJZD2005)。
作者简介
通信作者:李琳,副主任医师,E-mail:lilinxcy@126.com,https://orcid.org/0000-0002-3659-7529;张高钰,https://orcid.org/0000-0003-1809-2807。
