中国中西医结合杂志2024，Vol.44Issue(9)：1051-1062,12.DOI:10.7661/j.cjim.20240320.045
慢性心力衰竭合并原发性高血压病患者死亡预警指标研究
Warning Indicators for Cardiogenic Death during the Vulnerable Phase in Chronic Heart Failure with Concurrent Essential Hypertension
摘要
Abstract
Objective To investigate the warning indicators for cardiogenic death during the vulnerable phase in patients with coexisting essential hypertension and chronic heart failure,comparing Chinese and Western medicine approaches based on multiple support vector machine-recursive feature elimination(MSVM-RFE)and Cox regression analysis.Methods Patients with chronic heart failure and essential hypertension who met the study criteria from 7 Chinese medicine(CM)hospitals in Shandong Province were included in this prospective cohort study.A comprehensive collection of 78 clinical variables were obtained,including patient demographics,comorbidities,cardiac ultrasound results,laboratory test outcomes,CM syndrome information,and medication records.Endpoint events were counted at follow-up 3 months after discharge.Cox univariate regression analysis was employed to identify variables that exhibited a significant association with cardiogenic death during the vulnerable phase.These variables were subsequently incorporated as potential warning indicators in the MSVM-RFE model,and their relative importance was determined based on average ranking scores.The efficiency estimation was used to evaluate the model error rate and accuracy index in order to select the optimal subset of warning indicators.Additionally,the predictive property of the warning indicators were assessed through Cox multivariate regression analysis.Results Totally 1 721 patients were included in analyses,among whom 272 experienced cardiogenic death during the vulnerable phase.Subsequently,the Cox univariate regression analysis yielded 64 potential warning indicators,which were then prioritized based on their significance and successively incorporated into the MSVM-RFE model for efficiency estimation.The inclusion of the top 13 potential warning indicators resulted in the model attaining a minimum error rate of 0.136 and a maximum accuracy of 0.864,suggesting that this particular subset of warning indicators was optimal.Furthermore,Cox multivariate regression analysis demonstrated significant associations between the following factors and cardiogenic death during the vulnerable phase:plasma N-terminal pro-brain natriuretic peptide(NT-ProBNP)levels exceeding 1 000 ng/L(HR=3.65),the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers(ACEI/ARB,HR=0.66),the presence of qi-yin deficiency and blood stasis syndrome(HR=1.98),the manifestation of dark complexion and lips(HR=2.19),the administration of diuretic medication(HR=0.73),heart rate falling below 60 or exceeding 100 beats per minute(HR=1.30,HR=1.33),age surpassing 60 years(HR=3.64),New York Heart Association(NYHA)functional classification(Ⅲ vs Ⅱ:HR=2.50;Ⅳ vs Ⅱ:HR=3.58),a history of smoking(HR=1.78),and systolic blood pressure not exceeding 140 mmHg(HR=2.56),blood-activating Chinese herbal injections(HR=0.64),presence of a slippery pulse(HR=1.32),and the presence of scanty or cracked coating on the tongue(HR=1.45).Conclusions The study identified several detrimental warning indicators,including NT-ProBNP levels exceeding 1 000 ng/L,qi-yin deficiency and blood stasis syndrome,dark complexion and lips,heart rate falling below 60 or exceeding 100 per minute,age surpassing 60 years,NYHA functional classification reaching or exceeding Ⅲ,smoking history,systolic blood pressure not exceeding 140 mmHg,slippery pulse,and scanty or cracked coating on the tongue.On the other hand,the use of ACEI/ARB,diuretic medication,and blood-activating Chinese herbal injections were identified as protective warning indicators.The combined MSVM-RFE and Cox regression model proves to be a suitable approach for analyzing warning indicators.关键词
慢性心力衰竭/原发性高血压病/心衰易损期/中西医结合/预警指标/多重支持向量机-递归特征消除/Cox回归分析Key words
chronic heart failure/essential hypertension/vulnerable phase of heart failure/integrative medicine/warning indicators/multiple support vector machine-recursive feature elimination/Cox regression analysis引用本文复制引用
李润民,戴国华,高武霖,管慧,任丽丽,王兴蒙,曲惠文..慢性心力衰竭合并原发性高血压病患者死亡预警指标研究[J].中国中西医结合杂志,2024,44(9):1051-1062,12.基金项目
国家重点研发计划项目(No.2019YFC1710401) （No.2019YFC1710401）
国家自然科学基金项目(No.82174172) （No.82174172）
国家自然科学基金青年项目(No.82204942) （No.82204942）
山东省自然科学基金青年项目(No.ZR2022QH123) （No.ZR2022QH123）
中国博士后科学基金面上资助项目(No.2022M721998) （No.2022M721998）
