摘要
目的分析非小细胞肺癌(NSCLC)患者心血管特征及化疗后心率变异性(HRV)的危险因素,并构建HRV简易风险评分模型。方法单中心、回顾性研究。连续纳入2019年1月至2023年1月于北京大学肿瘤医院内蒙古医院治疗的267例NSCLC患者为研究对象,其中200例纳入训练集,包括男性120例,女性80例,平均年龄(48.6±5.2)岁,根据患者化疗后HRV情况分为HRV正常组(126例)和HRV异常组(74例),对比分析两组患者临床资料、心血管特征及HRV参数。另外67例纳入验证集,以验证简易评分模型的有效性。多因素logistic回归分析影响HRV的危险因素。多元logistic回归分析法分析各危险因素对HRV异常的预测能力,构建HRV简易风险预测模型并验证。结果HRV异常组QT间期延长、D-二聚体升高的患者比例均高于HRV正常组(均为P<0.05);正常RR期间标准差(SDNN)、相邻正常RR间期之差的均方根(RMSSD)、总功率(TP)、高频段功率(HF)、Poincaré散点图的椭圆半短轴的长度(SD1)、椭圆半长轴的长度(SD2)、近似熵(ApEn)、关联维数(CD)均显著低于HRV正常组(均为P<0.05);递归图定量分析中的平均对角线长度(Lmean)和递归率(REC)均高于HRV正常组(均为P<0.05)。多因素logistic回归分析结果显示,SDNN、RMSSD、HF、SD2、ApEn、Lmean和REC均是HRV异常的独立影响因素(均为P<0.05)。联合线性指标SDNN、RMSSD、HF和非线性指标SD2、ApEn、Lmean、REC可明显提高传统指标对HRV异常的预测能力(C值:0.864比0.745,NRI=0.849,IDI=0.409,均为P<0.001)。构建简易风险评分模型,将HRV异常风险划分为低危、中危、高危3个等级,模型评价结果显示其预测效能较好(训练样本AUC:0.814,验证样本AUC:0.882,Z=-2.163,P<0.05)。结论NSCLC患者化疗后HRV异常者易发生心律失常、血栓栓塞风险等心血管不良反应。SDNN、RMSSD、HF、SD2、ApEn、Lmean、REC均是影响HRV的独立影响因素。临床可根据HRV简易风险评分模型对易发生HRV异常的NSCLC患者进行早期筛查。
Objective To analyze the cardiovascular characteristics and risk factors for heart rate variability(HRV)after chemotherapy in patients with non-small cell lung cancer(NSCLC),and construct a simplified risk scoring model for HRV.Methods This was a single-center,retrospective study.A total of 267 patients with NSCLC treated in our hospital from January 2019 to January 2023 were selected as the study objects.Among them,200 patients were included in the training set,including 120 males and 80 females,with an average age of(48.6±5.2)years old,and were divided into normal group(126 cases)and abnormal group(74 cases)according to the HRV of the patients after chemotherapy.The clinical data,cardiovascular characteristics and HRV parameters of the two groups were compared.Another 67 cases were included in the training set to verify the effectiveness of the simplified scoring model.The risk factors of abnormal HRV were analyzed by multivariate logistic regression analysis.Multiple logistic regression analysis was used to analyze the predictive ability of each risk factor for abnormal HRV.The simplified risk scoring model for HRV anomaly was constructed and verified.Results The proportions of patients with prolonged QT interval and increased D-dimer in abnormal HRV group were higher than those in normal HRV group(both P<0.05),standard deviation of all normal-to-normal intervals(SDNN),root mean square of successive interval differences(RMSSD),total power(TP),high frequency power(HF),length of the semi-minor axis of the ellipse(SD1)and length of the semi-major axis of the ellipse(SD2),approximate entropy(ApEn)and correlation dimension(CD)were significantly lower than those of normal HRV group(all P<0.05);mean diagonal line length(Lmean)and recurrence rate(REC)in quantitative analysis of recursion graph were significantly higher than those in normal HRV group(both P<0.05).Logistic analysis showed that,SDNN,RMSSD,HF,SD2,ApEn,Lmean and REC were independent influencing factors for abnormal HRV(all P<0.05).The combination of linear indexes SDNN,RMSSD,HF and nonlinear indexes SD2,ApEn,Lmean and REC can significantly improve the predictive ability of traditional indexes to HRV anomalies(C-value:0.864 vs.0.745,NRI=0.849,IDI=0.409,P<0.001).A simplified risk scoring model was constructed to divide the abnormal risk of HRV into three levels:low risk,medium risk and high risk.The evaluation results of the model showed that the prediction efficiency was good(training sample AUC:0.814,verification sample AUC:0.882,Z=-2.163,P<0.05).Conclusions Patients with abnormal HRV after chemotherapy are prone to cardiovascular adverse reactions such as arrhythmia and thromboembolism risk.SDNN,RMSSD,HF,SD2,ApEn,Lmean and REC are all independent influencing factors for abnormal HRV.The simple risk score model can be used to accurately screen and prevent patients with abnormal HRV.
作者
聂莉莎
牟永平
赵能君
Nie Lisha;Mou Yongping;Zhao Nengjun(Department of Cardiogeriatrics,Inner Mongolia Hospital,Beijing University Cancer Hospital(Affiliated Cancer Hospital of Inner Mongolia Medical University),Hohhot 010020,China;Department of Laboratory,Inner Mongolia Hospital,Beijing University Cancer Hospital(Affiliated Cancer Hospital of Inner Mongolia Medical University),Hohhot 010020,China)
出处
《中国心血管杂志》
北大核心
2024年第6期554-562,共9页
Chinese Journal of Cardiovascular Medicine
关键词
心律失常
心性
心血管系统
危险因素
非小细胞肺癌
化疗
心率变异性
Arrhythmias,cardiac
Cardiovascular system
Risk factor
Non-small cell lung cancer
Chemotherapy
Heart rate variability
作者简介
通信作者:赵能君,电子信箱:zhaonengjun66@126.com。
