基于老年营养风险指数构建老年射血分数保留型心力衰竭患者的预后模型

doi:10.20047/j.issn1673-7210.2022.29.06

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摘要目的探究老年营养风险指数（GNRI）对评估老年射血分数保留型心力衰竭（HFpEF）患者预后的价值，并建立一个预测老年HFpEF患者预后的列线图模型。方法回顾性纳入2018年1月至2020年1月就诊于苏州大学附属第一医院，确诊为HFpEF的患者共135例，根据患者1年内是否出现主要心血管不良事件（MACE）分为病例组（44例）和对照组（91例）。收集患者的临床资料，计算GNRI，应用多因素logistic回归分析老年HFpEF患者预后不良的危险因素，运用R软件构建预测患者1年内发生MACE的列线图模型。结果病例组年龄，NYHA分级≥Ⅲ级、合并糖尿病的比例，肌酐、高敏肌钙蛋白T、N末端脑钠肽前体、肺动脉压力高于对照组，差异有统计学意义（P ＜ 0.05）；而血红蛋白、白蛋白、GNRI低于对照组，差异有统计学意义（P ＜ 0.05）。多因素logistic回归分析显示，入院时NYHA分级≥Ⅲ级（OR = 4.213，95%CI：1.476～12.022）、合并糖尿病比例（OR = 3.282，95%CI：1.198～8.990）是老年HFpEF患者1年内发生MACE的危险因素（OR > 1，P ＜ 0.05）；GNRI越高（OR = 0.919， 95%CI：0.853～0.990）是老年HFpEF患者1年内发生MACE的保护因素（OR < 1，P ＜ 0.05）。基于GNRI构建的Nomogram模型其ROC曲线下面积为0.816（95%CI：0.734～0.897，P ＜ 0.01）。结论入院时NYHA分级≥Ⅲ级、合并糖尿病是老年HFpEF患者1年内发生MACE的独立危险因素，而GNRI升高是其保护因素。本研究构建的列线图模型对老年HfpEF患者1年内预后有着良好的预测价值。

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	张铭炀王佐翔顾怡钰蒋廷波

关键词 ：老年射血分数保留型心力衰竭, 老年营养风险指数, 预后, 危险因素, 预后模型

Abstract：Objective To explore the value of geriatric nutritional risk index (GNRI) in evaluating the prognosis of elderly patients with heart failure with preserved ejection fraction (HFpEF), and to establish a nomogram model to predict the prognosis of elderly patients with HFpEF. Methods A total of 135 patients diagnosed with HFpEF in the First Affiliated Hospital of Soochow University from January 2018 to January 2020 were retrospectively included. The patients were divided into case group (44 cases) and control group (91 cases) according to whether major adverse cardiovascular events (MACE) occurred within a year. The clinical data of patients were collected, GNRI was calculated, and multivariate logistic regression was used to analyze the risk factors of poor prognosis in elderly patients with HFpEF. R software was used to construct a nomogram model to predict the occurrence of MACE in patients within a year. Results The age, the ratio of NYHA grade ≥ Ⅲ, the proportion of diabetes, creatinine, high-sensitivity troponin T, N-terminal brain natriuretic peptide precursor, and pulmonary artery pressure of the case group were higher than those of the control group, and the differences were statistically significant (P ＜ 0.05); while the hemoglobin, albumin and GNRI were lower than those in the control group, and the differences were statistically significant (P ＜ 0.05). Multivariate logistic regression analysis showed that the ratio of NYHA grade ≥ Ⅲ at admission (OR = 4.213, 95%CI: 1.476 to 12.022) and diabetes (OR = 3.282, 95%CI: 1.198 to 8.990) were the risk factors for the occurrence of MACE within a year in elderly patients with HFpEF (OR > 1, P ＜ 0.05); while higher GNRI (OR = 0.919, 95%CI: 0.853 to 0.990) was a protective factor for the occurrence of MACE in elderly patients with HFpEF within a year (OR < 1, P ＜ 0.05). The area under the ROC curve of the Nomogram model constructed based on GNRI was 0.816 (95%CI: 0.734 to 0.897, P ＜ 0.01). Conclusion NYHA grade ≥ Ⅲ at admission and diabetes mellitus are independent risk factors for MACE within a year in elderly patients with HFpEF, and higher GNRI is a protective factor. The nomogram model constructed in this study has a good predictive value for the prognosis of elderly HfpEF patients within a year.

Key words： Heart failure with preserved ejection fraction Geriatric nutritional risk index Prognosis Risk factors Prognostic model

基金资助:苏州市科技发展计划医疗器械与新医药项目（SLT201910）。

通讯作者: 蒋廷波（1965.6-），男，博士，主任医师，博士生导师；研究方向：心律失常的介入治疗。

作者简介: 张铭炀（1995.9-），男，苏州大学医学院临床医学系2019级内科学专业在读硕士研究生；研究方向：心力衰竭的基础与临床。

引用本文:

张铭炀王佐翔顾怡钰蒋廷波. 基于老年营养风险指数构建老年射血分数保留型心力衰竭患者的预后模型[J]. 中国医药导报, 2022, 19(29): 29-33.
ZHANG Mingyang WANG Zuoxiang GU Yiyu JIANG Tingbo. Construction of a prognostic model for elderly patients with heart failure with preserved ejection fraction based on geriatric nutritional risk index. 中国医药导报, 2022, 19(29): 29-33.

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