心力衰竭患者沙库巴曲缬沙坦耐受性预测模型构建探讨OACSTPCD
Construction and analysis of a prediction model for tolerance of sacubitril/valsartan in patients with heart failure
目的 探讨影响射血分数降低的心力衰竭(HFrEF)患者使用沙库巴曲缬沙坦(SV)耐受性的因素,构建列线图模型并评估预测价值.方法 纳入 2020 年 1 月至 2022 年 12 月浙江中医药大学附属温州市中医院心血管内科收治的HFrEF患者 150 例,收集所有患者临床资料,给予SV治疗;随访 3 个月,观察患者SV是否达到目标剂量(200 mg,2 次/d),分为耐受组 45 例和对照组105例.对比两组患者临床资料,采用多因素Logistic回归分析影响患者SV耐受性的相关因素,采用R软件建立列线图模型,绘制校正曲线、受试者工作特征(ROC)曲线评估模型在预测SV耐受性的内部效能.结果 30.00%患者达到了目标剂量.耐受组年龄低于对照组,收缩压、合并右心衰竭比例、体质量指数(BMI)、既往口服中等以上剂量血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)比例高于对照组,差异具有统计学意义(P＜0.05).多因素Logistic回归分析显示年龄、BMI、合并右心衰竭及服用中等以上剂量ACEI/ARB是SV耐受性的影响因素(OR=0.833、1.379、3.167、2.720,P＜0.05);以影响因素构建列线图模型,C-指数为 0.927(95%CI=0.889～0.984),模型校准曲线与理想模型相接近.ROC曲线分析显示,模型在预测SV耐受性的曲线下面积为 0.928,敏感度为 91.11%,特异度为 81.90%.结论 通过列线图构建预测模型可以评估患者使用SV的耐受性,指导临床治疗.
Objective To explore the factors affecting the tolerance of heart failure with reduced ejection fraction(HFrEF)patients to sacubitril/valsartan(SV),construct a nomogram model,and assess its predictive value.Methods A total of 150 HFrEF patients admitted to the cardiovascular department of Wenzhou TCM Hospital of Zhejiang Chinese Medical University from January 2020 to December 2022 were included.Clinical and laboratory data from all patients were collected.SV treatment was adopted.Patients were followed up for 3 months to observe whether reached the target dose of SV(200 mg,twice/day),and were divided into tolerance group(45 cases)and control group(105 cases)accordingly.Clinical data between two groups were compared.Multivariate Logistic regression analysis was used to identify factors affecting SV tolerance in patients.A nomogram model was established using R software,and calibration curve and receiver operating characteristic(ROC)curve were performed to evaluate the model's internal effecacy in predicting SV tolerance.Results Only 30.00%of patients reached the target dose.The age of the tolerance group was lower than that of the control group,and systolic blood pressure levels,proportion of combined right heart failure,body mass index(BMI),proportion of history of oral medium to high doses of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers(ACEI/ARB)in the tolerance group were higher than those of the control group,with statistically significant differences(P＜0.05).Multivariate Logistic regression analysis showed that age,BMI,combined right heart failure,and intake of medium to high doses of ACEI/ARB were influencing factors for SV tolerance(OR=0.833,1.379,3.167,2.720;P＜0.05).A nomogram model was constructed using these influencing factors,with a C-index of 0.927(95%CI=0.889-0.984).Calibration curve of the model closely matched the ideal model.ROC curve analysis showed that the area under the curve of predicting SV tolerance was 0.928,the sensitivity was 91.11%,and the specificity was 81.90%.Conclusion The construction of a nomogram model can assess SV tolerance of patients,providing guidance for clinical treatment.
姜祖超;葛乐品;叶海浩;王洁;林梅瑟
325000 温州,浙江中医药大学附属温州市中医院心血管内科325000 温州,浙江中医药大学附属温州市中医院治未病科
心力衰竭沙库巴曲缬沙坦耐受性列线图模型
Heart failureSacubitril/valsartanToleranceNomogram model
《心脑血管病防治》 2024 (003)
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