摘要
[目的]构建预测慢性阻塞性肺疾病(COPD)患者冠状动脉钙化风险的列线图模型,并评价列线图模型的预测效果。[方法]采用R软件对DRYAD数据库数据进行二次分析;通过多因素Logistic回归分析筛选COPD患者冠状动脉钙化风险的独立预测因素,依此构建个性化的列线图预测模型;采用受试者工作特征曲线(ROC)曲线评估列线图模型的预测效果。[结果]多因素Logistic回归分析结果表明,男性、年龄较大、使用他汀类药物和使用ACE抑制剂或ARB类降压药为COPD患者冠状动脉钙化发生的独立风险因素(P<0.05)。构建的列线图模型的ROC曲线下面积(AUC)为0.779,95%CI:0.725~0.834,提示列线图具有较好的区分度。Hosmer-Lemeshow拟合优度检验结果显示列线图的预测概率与冠状动脉钙化的实际发生频率之间的差异不具备统计学意义(χ^(2)=6.240,P=0.621),即列线图模型具有较好的校准度。DCA曲线表明,当COPD患者冠状动脉钙化发生的阈值概率处于0.26~0.96之间时,患者应用列线图模型获得的净收益明显优于“全干预”“不干预”方案,提示列线图模型具有较好的临床适用性。[结论]本研究构建的列线图预测模型可用于协助临床医务人员筛选出高冠状动脉钙化风险的COPD人群,制定个体化针对性干预方案,降低COPD患者冠状动脉钙化发生率。
Aim To construct a nomogram model for predicting the risk of coronary artery calcification in patients with chronic obstructive pulmonary disease(COPD)and evaluate its predictive efficiency.Methods The data of DRYAD database were analyzed by the R software.Multivariate Logistic regression analysis was used to screen independent predictors of coronary artery calcification risk in patients with COPD,and a personalized nomogram prediction model was constructed.Receiver operating characteristic(ROC)curve was used to evaluate the predictive effect of the nomogram model.Results Multivariate Logistic regression analysis showed that male,advanced age,use of statins and use of ACE inhibitors or ARB antihypertensive drugs were independent risk factors for coronary artery calcification in COPD patients(P<0.05).The area under the ROC curve(AUC)of the constructed nomogram model was 0.779,95%CI:0.725~0.834,suggesting that the nomogram had good discrimination.The Hosmer-Lemeshow goodness-of-fit test showed that there was no significant difference between the predicted probability of nomogram and the actual frequency of coronary artery calcification(χ^(2)=6.240,P=0.621),that is,the nomogram model had good calibration.The DCA curve showed that when the threshold probability of coronary artery calcification in COPD patients was between 0.26 and 0.96,the net benefit of patients using the nomogram model was significantly better than that of the“full intervention”and“no intervention”measures,suggesting that the nomogram model has good clinical applicability.Conclusion The nomogram prediction model constructed in this study can be used to assist clinical staff to screen out COPD populations with high risk of coronary calcification,formulate individualized targeted intervention plans,and reduce the incidence of coronary calcification in COPD patients.
作者
张理想
周晓娟
ZHANG Lixiang;ZHOU Xiaojuan(Department of Cardiology,the First Affiliated Hospital of University of Science and Technology of China,Hefei,Anhui 230036,China)
出处
《中国动脉硬化杂志》
CAS
2023年第11期981-988,共8页
Chinese Journal of Arteriosclerosis
基金
安徽省高等学校省级质量工程项目(2022jyxm1849)。
关键词
慢性阻塞性肺疾病
冠状动脉钙化
风险因素
列线图
chronic obstructive pulmonary disease
coronary artery calcification
risk factors
nomogram
