中国全科医学2026，Vol.29Issue(14)：1840-1848,9.DOI:10.12114/j.issn.1007-9572.2025.0397
基于中医证候及脉图参数构建原发性高血压伴左心室肥厚风险预测模型研究
Research on the Construction of a Risk Prediction Model for Primary Hypertension with Left Ventricular Hypertrophy Based on TCM Syndromes and Pulse Graph Parameters
摘要
Abstract
Background Early risk assessment of essential hypertension with left ventricular hypertrophy(EH-LVH)is crucial for clinical intervention,but existing predictive models often overlook Traditional Chinese Medicine(TCM)syndromes,pulse graph parameters,and other TCM clinical information.Therefore,integrating the aforementioned characteristic indicators to construct an EH-LVH risk prediction model will provide new evidence for risk stratification and clinical decision-making in integrated Traditional Chinese and Western Medicine.Objective To develop a nomogram model for predicting the risk of EH-LVH based on TCM syndromes and pulse graph parameters.Methods A total of 201 inpatients with essential hypertension admitted to Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,and Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from August 2018 to June 2021 were selected.Based on echocardiographic results,they were divided into the essential hypertension with left ventricular hypertrophy group(EH-LVH group)and the essential hypertension without left ventricular hypertrophy group(EH-NLVH group).General information,physicochemical indicators,and TCM inquiry data of the two groups were collected,and pulse graph parameters were detected using the SMART-Ⅰ TCM pulse analysis instrument.Multivariate Logistic regression analysis was used to explore factors independently associated with the risk of EH-LVH.Using the rms package in R software version 4.1.1,three nomogram models(Models A,B,and C)were established with pulse graph parameters,TCM syndromes,and pulse graph parameters+TCM syndromes+general information as variables,respectively.Receiver operating characteristic(ROC)curves were used to assess discrimination,calibration curves to evaluate accuracy,Hosmer-Lemeshow test to verify calibration,and decision curve analysis(DCA)to evaluate clinical utility,followed by model comparisons.Results Multivariate Logistic regression analysis showed that low-density lipoprotein cholesterol(OR=1.511,95%CI=1.709-2.115),Yin deficiency with Yang hyperactivity syndrome(OR=2.493,95%CI=1.272-4.885),Qi stagnation and blood stasis syndrome(OR=7.866,95%CI=2.201-28.110),T(OR=1.906,95%CI=1.278-2.842),H3/H1(OR=1.549,95%CI=1.021-2.351),and W1/T(OR=2.129,95%CI=1.369-3.310)were factors independently associated with the risk of EH-LVH(P<0.05).The areas under the ROC curves(AUC)of the nomogram models were as follows:the AUC of Model A was 0.642(95%CI=0.571-0.713),that of Model B was 0.717(95%CI=0.646-0.788),and that of Model C was 0.784(95%CI=0.719-0.849).The calibration results showed that for Model A:χ2=0.133(P>0.05),for Model B:χ2=4.316(P>0.05),and for Model C:χ2=3.754(P>0.05),indicating good agreement between the predicted probabilities and actual probabilities in the calibration curves of all three models.DCA curve analysis showed that when the threshold for predicting EH-LVH occurrence was between 0.05 and 0.80(estimated value),Model C achieved optimal applicability,indicating its more significant clinical utility value.Conclusion This study successfully construct a nomogram for predicting the risk of EH-LVH,with TCM syndromes and pulse graph parameters as core predictive variables.The discrimination performance and predictive accuracy of this nomogram were validated to be favorable,demonstrating value for clinical promotion and application,and it can serve as a reference for clinical risk assessment of this disease.关键词
原发性高血压/左心室肥厚/脉图参数/中医证候/预测模型Key words
Essential hypertension/Left ventricular hypertrophy/Pulse wave parameters/TCM syndromes/Prediction model分类
医药卫生引用本文复制引用
王斯曼,张梦楚,李文,许艾,徐璡,郭睿,燕海霞..基于中医证候及脉图参数构建原发性高血压伴左心室肥厚风险预测模型研究[J].中国全科医学,2026,29(14):1840-1848,9.基金项目
国家自然科学基金资助项目(81973749) （81973749）
