原发性高血压合并内皮功能障碍列线图预测模型建立

Construction of a nomogram model for the prediction of endothelial dysfunction in patients with essential hypertension

  • 摘要: 目的 探讨原发性高血压(EH)患者合并内皮功能障碍的独立影响因素,构建预测EH合并内皮功能障碍发生的个性化列线图模型。方法 回顾性收集2000年8月—2016年5月在福建医科大学附属第一医院老年医学科与全科医学科就诊的EH患者1 752例的临床资料,通过血流介导的肱动脉舒张功能(FMD)评估内皮功能。依据患者入组时间顺序分为建模组(n=1 204)和验证组(n=548),再按FMD≤7.1%和>7.1%将EH患者分为合并和不合并内皮功能障碍两组。运用单因素分析和多因素logistic回归分析建模组发生内皮功能障碍的独立影响因素,依此构建列线图。然后,分别通过受试者工作特征曲线下面积(AUC),校准曲线和Hosmer-Lemeshow检验,以及决策曲线评价模型的预测能力、校准度及临床适用性。结果 建模组中EH合并内皮功能障碍者441例,验证组中EH合并内皮功能障碍者103例。多因素logistic回归分析显示,建模组中共纳入6个EH合并内皮功能障碍的独立危险因素,分别为:年龄(OR=1.02,95%CI 1.01~1.03)、吸烟(OR=3.51, 95%CI 2.40~5.14)、白细胞偏高(OR=2.14, 95%CI 1.60~2.86)、收缩压偏高(OR=1.59,95%CI 1.23~2.05)、空腹血糖偏高(OR=1.44,95%CI 1.12~1.86)和腹型肥胖(OR=1.34,95%CI 1.04~1.73)(均P<0.05),依此构建预测模型的列线图。内部验证后,建模组和验证组的AUC值分别为0.70(95%CI 0.67~0.73)和0.74(95%CI 0.68~0.80),显示模型区分度良好。校准曲线和Hosmer-Lemeshow检验显示该模型预测结果与实际结果的一致性较好(建模组:χ2=2.05,P=0.36;验证组:χ2=0.72,P=0.70)。决策曲线验证了列线图具有临床适用性。结论 本研究构建的个性化列线图预测模型具有较好的预测能力、校准度及临床适用性,可方便直观地甄别出EH患者合并内皮功能障碍的高危人群,为其早期防治提供临床依据。

     

    Abstract: Objective To investigate the independent influencing factors of endothelial dysfunction in patients with essential hypertension(EH), and to construct a personalized nomogram model for predicting the occurrence of endothelial dysfunction in EH. Methods The clinical data of 1 752 EH patients admitted to the department of geriatrics and the department of general medicine of the First Affiliated Hospital of Fujian Medical University from August 2000 to May 2016 were retrospectively collected. Endothelial function was evaluated by flow-mediated dilation(FMD). EH patients were divided into training group(n=1 204) and validation group(n=548) according to the time sequence of enrollment. Then, the patients were segmented into endothelial dysfunction group(FMD≤7.1%) or normal endothelial function group(FMD>7.1%). Univariate analysis and multivariate logistic regression analysis were used to analyze the independent influencing factors of endothelial dysfunction, and nomogram model was constructed accordingly. The discrimination, calibration, and clinical applicability of the model were evaluated by area under the receiver operating characteristic curve(AUC),calibration curve and Hosmer-Lemeshow test and decision curve, respectively. Results There were 441 cases of EH with endothelial dysfunction in the training group, and 103 cases in the validation group. Multivariate logistic analysis showed that a total of 6 independent risk factors were included in the training group, including age(OR=1.02, 95%CI 1.01-1.03), smoking(OR=3.51, 95%CI 2.40-5.14), high level of white blood cell(OR=2.14, 95%CI 1.60-2.86), high level of systolic blood pressure(OR=1.59, 95%CI 1.23-2.05), high level of fasting blood glucose(OR=1.44, 95%CI 1.12-1.86) and abdominal obesity(OR=1.34, 95%CI 1.04-1.73)(all P<0.05). The nomogram of prediction model subsequently was established. After internal validation, the AUC values of the training group and the validation group were 0.70(95%CI 0.67-0.73) and 0.74(95%CI 0.68-0.80), respectively, indicating good differentiation. Calibration curve and Hosmer-Lemeshow test showed that the predicted results of the model were in good agreement with the actual results(the training group: χ~2=2.05, P=0.36; the validation group: χ~2=0.72, P=0.70). The decision curve also verified the clinical applicability of nomogram. Conclusion The personalized nomogram constructed in this study has the good prediction ability, calibration and clinical applicability, which can easily and intuitively identify the high-risk groups of EH patients with endothelial dysfunction, and provide clinical basis for early prevention and treatment.

     

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