列线图个体化预测老年慢性肾衰竭血液透析患者发生心脏瓣膜钙化模型的建立

    Establishment of a nomogram for personalized prediction model of heart valve calcification in elderly patients with chronic renal failure on hemodialysis

      摘要
    • 摘要: 目的 建立可有效个体化预测老年慢性肾衰竭（chronic renal failure，CRF）血液透析患者发生心脏瓣膜钙化（cardiac valve calcification，CVC）的列线图。方法 回顾性分析2015年12月至2018年12月因CRF于茂名市人民医院行血液透析治疗的老年患者的临床资料，分别使用单因素分析和Logistic回归分析发生CVC的独立危险因素，并建立相关列线图预测模型。结果 透析龄≥24个月（OR=7.488，95%CI 2.524~22.215）、糖尿病（OR=6.256，95%CI 2.624~14.919）、pAlb<200 mg/L（OR=5.623，95%CI 1.965~16.091）、钙磷乘积≥55 mg2/dL2（OR=3.954，95%CI 1.679~9.311）、全段甲状旁腺素≥100 ng/L（OR=6.883，95%CI 2.478~19.118）及C反应蛋白≥5 mg/L（OR=3.422，95%CI 1.424~8.221）是老年CRF血液透析患者发生CVC的独立危险因素（P<0.05）。基于以上6项独立危险因素建立列线图模型，并对该模型进行验证显示预测值同实际值基本一致，C-index指数为0.878（95%CI 0.852~0.904），表明该列线图模型具有良好的预测能力。结论 透析龄≥24个月、糖尿病、pAlb<200 mg/L、钙磷乘积≥55 mg2/dL2、全段甲状旁腺素≥100 ng/L及C反应蛋白≥5 mg/L是老年CRF血液透析患者发生CVC的独立危险因素，本研究建立的列线图模型可有效预测老年CRF血液透析患者发生CVC的概率。

       

      Abstract: Objective To establish a nomogram of effectively predicting the occurrence of cardiac valve calcification(CVC) in elderly patients with chronic renal failure(CRF) on hemodialysis.Methods Retrospective analysis was performed for clinical data of elderly patients undergoing hemodialysis from December 2015 to December 2018,using single factor and Logistic regression for analyzing the independent risk factors of CVC and establishing the correlation Nomogram prediction model.Results Dialysis age ≥ 24 months(OR=7.488,95%CI 2.524~22.215),diabetes mellitus(OR=6.256,95%CI 2.624~14.919),pAlb <200 mg/L(OR=5.623,95%CI 1.965~16.091),calcium & phosphorus product ≥ 55 mg2/dL2(OR=3.954,95%CI 1.679~9.311),iPTH ≥ 100 ng/L(OR=6.883,95%CI 2.478~19.118) and C-reactive protein(CRP) ≥ 5 mg/L(OR=3.422,95%CI 1.424~8.221) were independent risk factors for CVC in elderly CRF hemodialysis patients(P<0.05).Based upon the above six independent risk factors,a nomogram model indicated that the predicted value was basically consistent with the actual value and C-index index was 0.878(95%CI 0.852~0.904),indicating that this nomogram model had an excellent predictive capability.Conclusions Dialysis age ≥ 24 months,diabetes mellitus,pAlb <200 mg/L,calcium & phosphorus product ≥ 55 mg2/dL2,iPTH ≥ 100 ng/L and CRP ≥ 5 mg/L are independent risk factors for CVC in elderly CRF hemodialysis patients.The nomogram model can effectively predict the probability of CVC in elderly CRF hemodialysis patients.

       

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