接受ARNI治疗的老年慢性心衰病人死亡风险预测模型的构建

doi:10.3969/j.issn.1003-9198.2024.11.008

摘要/Abstract

摘要： 目的构建接受血管紧张素受体脑啡肽酶抑制剂(ARNI)治疗的老年慢性心力衰竭(心衰)病人死亡风险预测模型,为早期识别预后不良高危人群及制定更为有效的干预方案提供参考。方法回顾性纳入2018年1月至2020年1月于邯郸市第一医院就诊并接受ARNI治疗的老年慢性心衰病人183例,随访3年,死亡50例,存活133例;采用多因素Cox回归评估病人死亡的独立危险因素,并进一步构建老年慢性心衰病人死亡风险临床预测模型。结果全部病人的中位生存时间为25.0(22.0,34.0)个月,其中1年生存率为93.44%(171/183),2年生存率为82.51%(151/183),3年生存率为72.68%(133/183)。单因素及多因素Cox回归分析结果均显示,左室射血分数、左室舒张末期内径、N末端B型钠尿肽前体及肌钙蛋白Ⅰ水平与预后有关(均P<0.05)。进一步构建列线图模型,并利用ROC曲线对列线图的预测结果进行分析,结果显示,列线图预测病人1、2、3年生存率的曲线下面积分别为0.741、0.862、0.730。结论接受ARNI治疗的老年慢性心衰病人死亡可能与多种心脏结构功能指标有关,基于心脏结构功能指标构建的模型在预测病人死亡风险方面具有优势。

关键词: 血管紧张素受体脑啡肽酶抑制剂, 老年人, 慢性心力衰竭, 心脏结构, 心脏功能

Abstract: Objective To establish a prediction model of death risk in the elderly patients with chronic heart failure (CHF) treated with angiotensin receptor neprilysin inhibitors (ARNI), and to provide reference for early identification of high-risk patients with poor prognosis and formulation of more effective intervention programs. Methods A total of 183 elderly patients with CHF who received ARNI treatment in the First Hospital of Handan from January 2018 to January 2020 were retrospectively enrolled in this study, and were divided into death group (n=50) and survival group (n=133) according to the results of 3 years follow-up. The independent risk factors for death in elderly patients with CHF treated with ARNI were assessed by multivariate Cox regression analysis, and a prediction model of death risk was established. Results The median survival time of all patients was 25.0(22.0,34.0)months. The 1-year, 2-year, 3-year survival rate was 93.44% (171/183), 82.51% (151/183) and 72.68% (133/183), respectively. The results of multiple Cox regression analysis showed that left ventricular ejection fraction, left ventricular end-diastolic diameter, the levels of N-terminal pro-B-type natriuretic peptide and troponin Ⅰ were related to prognosis (P<0.05). ROC curve showed that the area under the curve of nomogram model predicting the 1-year, 2-year, 3-year survival rate was 0.741, 0.862 and 0.730, respectively. Conclusions The death risk of the elderly patients with CHF treated with ARNI may be related to a variety of cardiac structural and functional indicators. The model based on cardiac structural and functional indicators is more suitable in predicting the death risk of the patients.

Key words: angiotensin receptor enkephalase inhibitors, aged, chronic heart failure, cardiac structure, cardiac function

中图分类号:

R 541

闫洪娟, 史朋晓, 宋媛媛, 李艳, 冯丽莎, 罗秋华. 接受ARNI治疗的老年慢性心衰病人死亡风险预测模型的构建[J]. 实用老年医学, 2024, 38(11): 1116-1120.

YAN Hongjuan, SHI Pengxiao, SONG Yuanyuan, LI Yan, FENG Lisa, LUO Qiuhua. Establishment of prediction model of death risk in elderly patients with chronic heart failure treated with ARNI[J]. Practical Geriatrics, 2024, 38(11): 1116-1120.

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