暴发性心肌炎患者早期风险评估模型的建立
Establishment of early risk assessment model for fulminant myocarditis
陈鑫 1林丽梅 2王来成 3林梅 1游静 1郑璇 1王爱玲 1彭峰1
作者信息
- 1. 福建医科大学附属第一医院心血管内科,福建福州 350005;福建医科大学附属第一医院滨海院区国家区域医疗中心心血管内科
- 2. 长乐区人民医院老年科
- 3. 福建医科大学附属协和医院心血管内科
- 折叠
摘要
目的 探讨识别成人暴发性心肌炎(FM)的潜在危险因素,建立早期风险评估模型.方法 回顾性分析2013-2021年福建医科大学附属第一医院和2017-2021年福建医科大学附属协和医院收治的268例心肌炎患者.使用多因素logistic回归分析FM的危险因素,最后纳入筛选出的独立危险因素建立Nomogram风险评估模型,采用受试者工作特征(ROC)曲线评估风险评估模型的区分度,采用决策曲线分析(DCA)评估风险评估模型的临床实用性.结果 本研究共纳入268例心肌炎患者,其中FM 53例,非暴发性心肌炎(NFM)215例.逐步logistic 回归分析显示,年龄(OR=1.869,95％CI 1.119～3.120,P=0.017)、传导阻滞/心动过缓(OR=38.700,95％CI 4.191～357.343,P=0.001)、心包积液(微量:OR=29.093,95％CI 0.393～2 155.855,P=0.125;少量:OR=12.449,95％CI 1.360～113.976,P=0.026;中量:OR=34.610,95％CI 1.185～1 010.446,P=0.040)、氨基末端脑利尿钠肽前体(NT-ProBNP)(OR=1.013,95％CI 1.000～1.025,P=0.042)、心肌肌钙蛋白 Ⅰ(cTnⅠ)(OR=1.170,95％CI 1.008～1.358,P=0.038)、血糖(OR=1.439,95％CI 1.179～1.757,P＜0.001)、血钙(OR=0.529,95％CI 0.421～0.665,P=0.017)、左室射血分数(LVEF)(OR=0.484,95％CI 0.264～0.886,P=0.019)是FM的独立影响因素.基于逐步回归分析结果中的8项独立影响因素建立的Nomogram预测模型具有较好的预测能力,其ROC曲线下面积(AUC)为0.95(95％CI 0.94～0.98).DCA表明,模型在较大的阈值内均有较高的获益性.结论 年龄、传导阻滞/心动过缓、心包积液、NT-proBNP、cTnⅠ、血糖、血钙、LVEF是FM的独立影响因素,根据影响因素构建的Nomogram模型对FM有较高的预测价值.
Abstract
Objective To identify potential risk factors for adult fulminant myocarditis(FM)and establish a early risk assessment model based on significant factors.Methods Retrospective analysis of 268 patients with myocardi-tis admitted to the first affiliated hospital of Fujian Medical University from 2013-2021 and the Fujian Medical Uni-versity Union Hospital from 2017-2021.Risk factors for FM identified by multivariate logistic regression analysis were used to create a Nomogram.Receiver operating characteristic curve(ROC)was used to evaluate the differentia-tion of Nomogram,and decision curve analysis(DCA)was used to evaluate the clinical usefulness.Results Of the 268 patients with myocarditis,215 patients were diagnosed with non-fulminant myocarditis(NFM),and 53 with FM.Stepwise regression analysis showed that age(OR=1.869,95％CI 1.119-3.120,P=0.017),conduction block or bradycardia(OR=38.700,95％CI 4.191-357.343,P=0.001),hydropericardium(trace:OR=29.093,95％CI 0.393-2 155.855,P=0.125;small:OR=12.449,95％CI 1.360-113.976,P=0.026;medium:OR=34.610,95％CI 1.185-1 010.446,P=0.040),N-terminal pro-B-type natriuretic peptide(NT-proBNP)(OR=1.013,95％CI 1.000-1.025,P=0.042),cardiac troponin Ⅰ(cTnⅠ)(OR=1.170,95％CI 1.008-1.358,P=0.038),blood glucose(OR=1.439,95％CI 1.179-1.757,P＜0.001),blood calcium(OR=0.529,95％CI 0.421-0.665,P=0.017)and left ventricular ejection fraction(LVEF)(OR=0.484,95％CI 0.264-0.886,P=0.019)were independent influencing factors for FM.The Nomogram model based on the eight influencing factors had good prediction effect.The area under the ROC curve(AUC)was 0.95(95％CI 0.94-0.98).Conclusion Age,conduction block or bradycardia,hydropericardium,NT-proBNP,cTnⅠ,blood glucose,blood cal-cium,and LVEF were independent risk factors for FM,and the Nomogram model constructed on the basis of risk factors had a high predictive value for FM.
关键词
暴发性心肌炎/风险评估模型/危险因素/Nomogram模型Key words
fulminant myocarditis/risk assessment model/risk factors/Nomogram model引用本文复制引用
基金项目
福建省自然科学基金(2022J01692)
福建省科技创新联合资金项目(2021Y9121)
福建省对外合作项目(202110013)
出版年
2024
NETL
NSTL
万方数据