心脏再同步化治疗患者临床预后风险评分系统的构建与验证

发布时间：2018-03-19 21:41

  本文选题：心脏再同步治疗　切入点：危险性评估　出处：《中国循环杂志》2017年08期 　论文类型：期刊论文

【摘要】：目的:创建并验证心脏再同步化治疗(CRT)患者临床预后的风险评分系统。方法:连续纳入2010-01至2015-12于我院首次接受CRT的患者367例。随访终点事件为全因死亡(包括心脏移植)和心力衰竭再住院。随机选取300例患者为建模组构建风险评分系统,其余67例为验证组进行验证。采用Cox风险比例回归模型建立评分系统;受试者工作特征(ROC)曲线下面积(AUC)评价并对比HEAL评分与EARRN评分的区分度;Hosmer-Lemeshow法评价拟合优度;Kaplan-Meier法比较不同评分患者的临床终点。结果:建模组分析显示,高敏C反应蛋白(HR=1.137,95%CI:1.072~1.205,P0.001)、大内皮素-1(HR=1.934,95%CI:1.066~3.507,P=0.03)、左心房前后径(HR=1.045,95%CI:1.007~1.084,P=0.02)、纽约心脏协会(NYHA)心功能Ⅳ级(HR=2.583,95%CI:1.331~5.013,P=0.005)是CRT患者不良预后的独立危险因素。依据危险因素β偏回归系数建立HEAL评分,根据分值划定患者危险分级:4分为低危,4~10分为中危,10分为高危。低、中、高危分级在建模组和验证组的ROC曲线下面积分别为0.719(95%CI:0.629~0.809)和0.708(95%CI:0.539~0.878),该评分可良好地区分不同危险分级患者的临床预后(Log-rank检验,建模组P0.001,验证组P=0.002)。Hosmer-Lemeshow拟合优度较好(P=0.952)。对367例患者分别采用HEAL评分与EARRN评分,发现HEAL评分(AUC:0.763,95%CI:0.692~0.833)较EARRN评分(AUC:0.602,95%CI:0.517~0.687)区分度更高。结论:HEAL评分能有效地预测CRT患者不良预后,区分度优于EARRN评分,对于识别高危患者具有临床实践价值。
[Abstract]:Objective: to establish and verify a risk scoring system for clinical prognosis in patients with cardiac resynchronization therapy. Methods: 367 consecutive patients who received CRT for the first time in our hospital from 2010-01 to 2015-12 were included. Three hundred patients were randomly selected as the model group to construct a risk scoring system. The other 67 cases were verified by the validation group. The Cox risk proportional regression model was used to establish the scoring system. The area under the operating characteristic curve was evaluated and compared between HEAL scores and EARRN scores. Hosmer-Lemeshow method was used to evaluate the clinical endpoints of patients with different scores by Kaplan-Meier method. Results: modeling group analysis showed that, Gao Min C-reactive protein (HR1.137 / 95CI: 1.0721.205U P0.001), et 1.93495CI1: 1.0663.507P0.03), left atrial anterior and posterior diameter HR1.045-95: CI1.0071.084P0.02, NYHA 鈪，

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