ARS评分表对原醛肾上腺瘤术后高血压预后的评价

发布时间：2018-03-27 05:01

本文选题：原发性醛固酮增多症　切入点：肾上腺瘤手术　出处：《福建医科大学》2015年硕士论文

【摘要】：【目的】验证Aldosteronoma Resolution Score(简称ARS评分表)在预测接受肾上腺瘤(ALD-producing adenoma,APA)患者术后高血压的治愈情况的准确性,评价其临床应用价值;并通过引入新的变量进一步完善ARS评分表,以期建立一种可以更准确预测原醛症患者肾上腺瘤术后高血压预后情况的评分表。【方法】收集2002年1月-2014年12月间,来自两家医院共115例APA引起原发性醛固酮增多症患者的临床资料,包括:一般信息、病史信息、实验室和检查资料,以及高血压的预后情况和降压药的使用种类等,。利用ARS评分表对患者进行评估分级。,绘制受试者工作曲线(ROC曲线),评价ARS评分表的应用价值。利用单因素分析,筛选影响APA术后高血压预后的其它影响因素,logistic回归分析验证其相关性,在原ARS评分表的基础上,将有统计学意义的新变量--高血压家族史、术后第一天血压引入,按照各变量标准化系数的大小,将变量赋值并组成改良ARS评分表。绘制改良ARS评分表的ROC曲线,评价其对APA患者术后高血压预后的预测准确性。进一步对比两种评分表的ROC曲线,比较两种评分表的准确性和评估其应用价值。【结果】原版ARS评分表ROC曲线下的面积为0.903,改良ARS评分表曲线下面积为0.945,经检验均有统计学意义(P0.05),说明两种ARS评分表对于原醛肾上腺瘤术后高血压的预后评估均存在应用价值。原版ARS评分表临界点为1和3,以1分和3分作为临界点,根据ROC曲线将改良ARS评分表分为如下3个等级:低等(0—1分);中等(2—3分);高等(4—5分),所对应的高血压治愈率分别是27.3%、77.8%和100%。根据改良ROC曲线确定临界点为3和8,以3分和8分作为临界点将改良ARS评分表分为如下3个等级:低等(0-3分)、中等(4-7分)和高等(8-11分),所对应的高血压治愈率分别是0、60.5%和98.5%。两种ARS评分表均表明,评分等级越高,高血压预后的预测准确性越高。比较两种评分表的高血压治愈率,改良ARS评分表高分段的治愈率更高,而低分段的治愈率更低,P0.05,有统计学意义(P0.05,),说明改良ARS评分表对原醛肾上腺瘤术后高血压预后的评估更好。比较ROC曲线,改良ARS评分表的ROC曲线更靠近左上角,曲线下面积(AUC)更大,因此改良ARS评分表比原版ARS评分表准确性和应用价值更好。【结论】原版ARS评分表对于APA患者术后高血压的预后评估有应用价值。六个变量--性别、身高体重指数BMI、术前高血压病程、术前抗高血压药物种类、高血压家族史和术后第一天血压均与APA术后高血压预后相关,利用上述变量组成的改良ARS评分表也存在应用价值。比较两种评分表的高血压治愈的预测准确性和ROC曲线,均说明在本研究中改良ARS评分表比原版ARS评分表准确性和应用价值更高。
[Abstract]:[objective] to verify the accuracy of Aldosteronoma Resolution score (ARS scale) in predicting the cure of hypertension after adrenal tumor ALD-producing adenoma, and to evaluate its clinical application value, and to improve the ARS score table by introducing new variables. [methods] to establish a scoring table that can more accurately predict the prognosis of hypertension after adrenal neoplasms in patients with proaldehydes. [methods] from January 2002 to December 2014, Clinical data of 115 patients with primary aldosteronism caused by APA from two hospitals, including general information, medical history information, laboratory and laboratory data, The prognosis of hypertension and the use of antihypertensive drugs were evaluated by ARS scale. The operating curve of subjects was drawn to evaluate the application value of ARS score table, and the single factor analysis was used. Other factors influencing the prognosis of hypertension after APA were screened. Logistic regression analysis was used to verify the correlation. On the basis of the original ARS score table, the family history of hypertension, a statistically significant new variable, was introduced into the blood pressure on the first day after operation. According to the size of the standardized coefficient of each variable, the variables are assigned and the modified ARS scoring table is formed. The ROC curve of the modified ARS scoring table is drawn. To evaluate its accuracy in predicting the prognosis of hypertension after APA. Further compare the ROC curves of the two scoring tables. [results] the area under the ROC curve of the original ARS scoring table is 0.903, and the area under the modified ARS scoring table curve is 0.945. The critical points of the original ARS scale were 1 and 3, with 1 and 3 as the critical points. According to the ROC curve, the modified ARS score scale is divided into the following three grades: low grade 0-1 score, middle grade 2-3 minutes, high grade 4-5 minutes, the corresponding cure rate of hypertension is 27.3% and 100th respectively. According to the modified ROC curve, the critical points are 3 and 8, and the critical points are 3 and 8 respectively, and the corresponding cure rates of hypertension are 27.3% and 100th, respectively. According to the modified ROC curve, the critical points are determined to be 3 and 8. The improved ARS score scale was divided into three grades as follows: low grade 0-3 scores, medium scale 4-7 scores) and higher scores of 8-11 points. The corresponding cure rates of hypertension were 0% and 98.5%, respectively. The two kinds of ARS scores showed that. The higher the score, the higher the accuracy of predicting the prognosis of hypertension. The cure rate of low segment was lower than that of P0.05, which showed that the modified ARS scale was better in evaluating the prognosis of hypertension after adrenal neoplasms. Compared with the ROC curve, the ROC curve of the modified ARS scale was closer to the upper left corner. The area under the curve is larger, so the improved ARS scoring table has better accuracy and application value than the original ARS scoring table. [conclusion] the original ARS scoring table is valuable in evaluating the prognosis of postoperative hypertension in APA patients. Height and body mass index (BMI), duration of hypertension before operation, kinds of antihypertensive drugs before operation, family history of hypertension and blood pressure on the first day after APA were all related to the prognosis of hypertension after APA. The modified ARS scale, which is composed of the above variables, also has application value. The accuracy of predicting hypertension cure and the ROC curve of the two scoring tables are compared. All of these indicate that the improved ARS scoring table is more accurate and more valuable than the original ARS scoring table in this study.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R736.6;R544.1

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