心脑血管病防治2025，Vol.25Issue(9)：26-30,5.DOI:10.3969/j.issn.1009-816x.2025.09.006
冠心病合并焦虑患者主要不良心脏事件发生风险预测模型的构建
Construction of a risk prediction model for major adverse cardiac events in patients with coronary heart disease complicated with anxiety
摘要
Abstract
Objective To construct and validate a risk prediction model for the occurrence of major adverse cardiac events in patients with coronary heart disease(CHD)complicated with anxiety.Methods Prospectively,70 patients diagnosed with CHD complicated with anxiety at the First Hospital of Handan from April 2021 to March 2022 were selected as the study subjects.After the 1-year follow-up,patients were divided into the adverse group(13 cases)and the favorable group(57 cases)based on the occurrence of major adverse cardiac events(MACE).Additionally,30 patients with CHD complicated with anxiety from March 2022 to March 2023 were selected as an external validation set for the prediction model.Baseline clinical data were collected,Generalized Anxiety Disorder-7(GAD-7)scale scores were assessed,and serum levels of brain derived neurotrophic factor(BDNF)and ghrelin were measured.Univariate and multivariate Logistic regression analyses were performed to identify influence factors for MACE in CHD patients complicated with anxiety,followed by the construction of a risk prediction model for MACE in CHD patients complicated with anxiety.The agreement between observed incidence rates and predicted incidence rates was assessed using a calibration plot.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive value of the risk model,while calibration curves with Hosmer-Lemeshow tests were employed to determine the model's goodness-of-fit.Results During the follow-up period,the incidence of MACE among study participants was 18.57%(13/70).Statistically significant differences were observed between the favorable and adverse groups in age,malnutrition,GAD-7 scores,BDNF,and ghrelin levels(P<0.05).Multivariate Logistic regression analysis showed that age,GAD-7 scores,BDNF,and ghrelin levels were influence factors for the occurrence of MACE in CHD patients complicated with anxiety(OR=0.558,0.835,1.092,1.486;P<0.05).The risk prediction model for MACE in CHD patients complicated with anxiety was defined as:Logit(P)=12.721-0.584×age-0.833×GDA-7 score+2.583×BDNF+1.910×ghrelin.The area under the ROC curve(AUC)was 0.936(95%CI=0.863-1.000),and its sensitivity and specificity was 85.7%and 91.1%,respectively.The Hosmer-Lemeshow goodness-of-fit test indicated good consistency of the model(χ2=4.621,P>0.05).The calibration curve of the risk prediction model for MACE in CHD patients complicated with anxiety closely aligned with the ideal curve.In the validation set,the AUC was 0.926(95%CI=0.841-1.000),with a sensitivity of 92.9%and specificity of 87.5%.The Hosmer-Lemeshow goodness-of-fit test indicated good consistency of the model(χ2=5.203,P>0.05).The calibration curve is close to the reference line,suggesting good consistency of the model.Conclusion Age,GAD-7 score,BDNF and ghrelin are the influencing factors of MACE in CHD patients complicated with anxiety.The risk prediction model for MACE in CHD patients complicated with anxiety constructed based on the above influence factors has good evaluation efficacy and predictive value.关键词
冠心病/焦虑/脑源性神经营养因子/胃饥饿素Key words
Coronary heart disease/Anxiety/Brain derived neurotrophic factor/Ghrelin引用本文复制引用
李红杰,李鹏,马玉莲,谢志江,李琴,郭俊花,李志梅,宋玮..冠心病合并焦虑患者主要不良心脏事件发生风险预测模型的构建[J].心脑血管病防治,2025,25(9):26-30,5.基金项目
邯郸市科学技术研究与发展计划项目(22422083075ZC) （22422083075ZC）
