慢性肾脏病左心室肥厚的风险因素及其预测模型的构建

肖芝梅; 丁晨慧; 骆臣; 钱蕾蕾

doi:10.16766/j.cnki.issn.1674-4152.003635

慢性肾脏病左心室肥厚的风险因素及其预测模型的构建

doi: 10.16766/j.cnki.issn.1674-4152.003635

南通大学附属如皋医院(江苏省如皋市人民医院)肾内科，江苏如皋 226500

基金项目:

江苏省2019年高层次卫生人才“六个一工程”拔尖人才科研项目 LGY201926

南通市卫生健康委科研课题 QA2020051

详细信息

通讯作者:
钱蕾蕾，E-mail：ntsqll@163.com

中图分类号: R692;R542.2
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- 文章访问数: 3
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- 被引次数: 0
出版历程
- 收稿日期: 2023-09-25
- 网络出版日期: 2024-11-19

Risk factors of left ventricular hypertrophy for chronic kidney disease patients and construction of a predictive model

Department of Nephrology, Rugao Hospital Affiliated to Nantong University (Rugao People ' s Hospital, Jiangsu Province), Rugao, Jiangsu 226500, China

摘要

摘要: 目的构建慢性肾脏病(CKD)患者左心室肥厚(LVH)的风险预测模型，评价其临床应用价值。方法收集2018年1月—2022年8月间南通大学附属如皋医院收治的302例CKD Ⅲ~Ⅴ期患者的临床资料, 将患者按随机数字表法分为建模组(200例)与验证组(102例)。采用logistic回归分析研究LVH的危险因素并构建列线图模型，通过受试者工作特征曲线与校正曲线评价模型的预测能力。结果 CKD患者LVH发生率为37.4%(113/302)。高龄(OR=1.054，95% CI: 1.020~1.089, P=0.002)、心血管病史(OR=5.826，95% CI: 2.263~15.003, P < 0.001)、CKD Ⅴ期(OR=5.831, 95% CI: 2.142~15.873, P=0.009)、收缩压升高(OR=1.019, 95% CI: 1.002~1.036, P=0.025)和高血磷(OR=1.109, 95% CI: 1.029~1.195, P=0.007)均是LVH的独立风险因素。基于上述因素构建预测模型，建模组与验证组AUC分别为0.850(95% CI: 0.796~0.904)和0.792(95% CI: 0.707~0.877)。校正曲线显示模型对LVH具有较好的预测能力。结论基于年龄、心血管疾病史、CKD分期、收缩压和血磷的列线图模型为识别高LVH风险的CKD患者提供了一项简便、有效的工具。
- 慢性肾脏疾病 /
- 左心室肥厚 /
- 风险因素 /
- 列线图 /
- 预测模型
Abstract: Objective To construct a predictive model for assessing the risk of left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD) and evaluate its clinical application value. Methods The clinical data of 302 patients with stage Ⅲ-Ⅴ CKD, who were treated at Rugao Hospital Affiliated to Nantong University from January 2018 to August 2022 were collected. Patients were randomly divided into a modeling group (n=200) and a validation group (n=102) based on their ID number. Logistic regression was used to determine risk factors for LVH, and a nomogram model was constructed. The predictive ability of the model was evaluated by receiver operating characteristic curve and correction curve. Results The incidence of LVH in CKD patients was 37.4% (113/302). Older age (OR=1.054, 95% CI: 1.020-1.089, P=0.002), cardiovascular history (OR=5.826, 95% CI: 2.263-15.003, P < 0.001), CKD Ⅴ stage (OR=5.831, 95% CI: 2.142-15.873, P=0.009), elevated systolic blood pressure (OR=1.019, 95% CI: 1.002-1.036, P=0.025) and hyperphosphatemia (OR=1.109, 95% CI: 1.029-1.195, P=0.007) were independent risk factors for LVH. The prediction model of LVH was constructed based on the above factors, and had AUC of 0.850 (95% CI: 0.796-0.904) in the modeling group and 0.792 (95% CI: 0.707-0.877) in validation group. The calibration curve showed that the nomogram model exhibits good predictive ability for LVH. Conclusion The nomogram model, which is based on age, history of cardiovascular disease, CKD stage, systolic blood pressure, and blood phosphorus, provides clinicians a simple and effective tool to identify CKD patients with high risk of LVH.
- Chronic kidney disease /
- Left ventricular hypertrophy /
- Risk factors /
- Nomogram /
- Predictive model

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图 1 慢性肾脏病LVH的预测列线图模型

Figure 1. Predictive nomogram model of LVH in chronic kidney disease patients

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图 2 列线图模型预测LVH的ROC曲线

Figure 2. ROC curves of the nomogram model for predicting LVH

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图 3 列线图模型预测LVH的校正曲线

注：A为建模组，B为验证组。

Figure 3. Calibration curves of the nomogram model for predicting LVH

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表 1 建模组和验证组慢性肾脏疾病患者基线资料比较

Table 1. Comparisons of baseline characteristics of chronic kidney disease patients between the modeling group and the validation group

基线特征	总计(n=302)	建模组(n=200)	验证组(n=102)	统计量	P值
年龄(x±s, 岁)	57.4±11.6	57.9±11.7	56.5±11.2	0.998^a	0.319
性别[例(%)]				1.136^b	0.286
女性	141(46.7)	89(44.5)	52(51.0)
男性	161(53.3)	111(55.5)	50(49.0)
BMI(x±s)	22.9±2.6	23.1±2.6	22.6±2.4	1.621^a	0.106
基础疾病[例(%)]
糖尿病	139(46.0)	95(47.5)	44(43.1)	0.518^b	0.472
高血压	86(28.5)	57(28.5)	29(28.4)	0.001^b	0.990
COPD	47(15.6)	30(15.0)	17(16.7)	0.143^b	0.706
CKD分期[例(%)]				0.800^b	0.670
Ⅲ	181(59.9)	120(60.0)	61(59.8)
Ⅳ	76(25.2)	48(24.0)	28(27.5)
Ⅴ	45(14.9)	32(16.0)	13(12.7)
eGFR[x±s，mL/(min·1.73 m²)]	32.6±14.6	31.9±15.1	33.8±13.5	0.390^a	0.697
SBP(x±s，mmHg)	134.4±21.2	135.3±22.6	132.5±18.0	1.087^a	0.278
DBP(x±s，mmHg)	81.8±11.2	81.7±11.7	82.1±10.4	0.291^a	0.771
尿白蛋白[M(P₂₅, P₇₅)，g/24 h]	1.09(0.51，1.56)	1.22(0.60，1.56)	1.06(0.52，1.41)	1.632^c	0.104
血清白蛋白(x±s，g/L)	40.2±4.0	39.9±4.2	40.8±3.8	1.818^a	0.070
尿酸(x±s，mg/dL)	6.6±1.9	6.6±1.9	6.2±1.8	1.791^a	0.079
血红蛋白(x±s，g/L)	117.6±21.0	116.1±21.1	120.8±21.6	1.816^a	0.070
血清总胆固醇(x±s，mg/dL)	203.4±46.1	204.0±47.9	202.2±42.6	0.320^a	0.749
C反应蛋白(x±s，mg/L)	1.70±0.32	1.65±0.27	1.68±0.42	0.751^a	0.453
iPTH[M(P₂₅, P₇₅)，pg/mL]	55.0(43.0，108.0)	54.0(43.0，103.0)	55.0(43.0，86.0)	-0.680^c	0.496
血钙(x±s，mmol/L)	2.27±0.28	2.27±0.28	2.26±0.19	0.324^a	0.746
血磷[M(P₂₅, P₇₅)，mmol/L]	1.20(1.02，1.44)	1.19(1.01，1.44)	1.20(1.03，1.45)	0.906^c	0.366
血钠(x±s，mmol/L)	136.2±4.9	135.9±5.0	136.8±4.8	1.499^a	0.135
血钾[M(P₂₅, P₇₅)，mmol/L]	4.5(4.0，5.2)	4.5(4.0，5.1)	4.6(4.2，5.3)	0.972^c	0.332
LVH[例(%)]				0.044^b	0.834
否	189(62.6)	126(63.0)	63(61.8)
是	113(37.4)	74(37.0)	39(38.2)
注：^a为t值，^b为χ²值，^c为Z值。1 mmHg=0.133 kPa。

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表 2 CKD患者LVH风险因素的logistic回归分析(建模组)

Table 2. Logistic regression analysis of risk factors for LVH in CKD patients (from the training group)

变量	单因素logistic分析		多因素logistic分析
变量	OR(95% CI)	P值	OR(95% CI)	P值
年龄	1.073(1.042~1.105)	< 0.001	1.054(1.020~1.089)	0.002
性别(男性)	0.640(0.360~1.137)	0.128
BMI	1.025(0.920~1.142)	0.653
糖尿病史	0.863(0.487~1.529)	0.614
心血管疾病史	5.261(2.327~11.893)	< 0.001	5.826(2.263~15.003)	< 0.001
COPD	2.025(0.936~4.381)	0.073
CKD分期
Ⅳ期	2.093(1.031~4.246)	0.041	2.196(0.967~4.984)	0.060
Ⅴ期	7.890(3.401~18.302)	< 0.001	5.831(2.142~15.873)	0.009
SBP	1.017(1.004~1.031)	0.010	1.019(1.002~1.036)	0.025
DBP	0.991(0.956~1.016)	0.457
尿白蛋白	0.912(0.659~1.261)	0.576
血清白蛋白	0.422(0.206~0.863)	0.018	0.752(0.280~2.025)	0.573
尿酸	1.072(0.921~1.246)	0.370
血红蛋白	0.791(0.684~0.916)	0.002	0.916(0.742~1.130)	0.412
血清总胆固醇	0.999(0.993~1.005)	0.771
C反应蛋白	1.300(1.038~1.629)	0.022	1.047(0.777~1.411)	0.762
iPTH	1.016(1.011~1.022)	0.007	1.024(0.898~1.168)	0.724
血钙	0.838(0.356~1.970)	0.685
血磷	1.128(1.054~1.208)	< 0.001	1.109(1.029~1.195)	0.007
血钠	1.092(0.806~1.479)	0.570
血钾	1.008(0.998~1.018)	0.105
注：变量赋值如下，性别(女性=0, 男性=1)，糖尿病(否=0, 是=1)，心血管疾病(否=0, 是=1)，COPD(否=0, 是=1)，CKD分期(Ⅲ期=1, Ⅳ期=2，Ⅴ期=3)，其余变量均为连续型变量, 均以实际值赋值。

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