中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (09): 726-731.doi: 10.3969/j.issn.1671-4091.2025.09.002

• 临床研究 • 上一篇    下一篇

维持性血液透析患者并发心力衰竭的风险预测模型构建

刘秋艳    晏现丽    张 悦   

  1. 450007 郑州，1河南省直第三人民医院肾病内科
  • 收稿日期:2024-10-28 修回日期:2025-06-03 出版日期:2025-09-12 发布日期:2025-09-12
  • 通讯作者: 刘秋艳 E-mail:LZQsp15@163.com

Research on the construction of Nomogram model for risk prediction of heart failure in maintenance hemodialysis

LIU Qiu-yan, YAN Xian-li, ZHANG Yue   

  1. Department of Nephrology, The Third People's Hospital of Henan Province, Zhengzhou 450007, China
  • Received:2024-10-28 Revised:2025-06-03 Online:2025-09-12 Published:2025-09-12
  • Contact: 450007 郑州，1河南省直第三人民医院肾病内科 E-mail:LZQsp15@163.com

摘要： 目的  构建维持性血液透析并发心力衰竭的风险预测列线图(Nomogram)模型。方法  回顾性分析河南省直第三人民医院2020年9月—2023年7月行维持性血液透析患者的病历资料，以2:1比例分为模型组和验证组。根据心力衰竭的发生情况将模型组分为并发组和未并发组。采用Logistic回归分析筛选维持性血液透析患者并发心力衰竭的风险因素，构建风险预测Nomogram模型并对该模型进行验证。 结果  共纳入312例患者，其中模型组208例，验证组104例；模型组中68例并发心力衰竭，发生率为32.69%。模型组Logistic回归分析显示高血压(OR=2.046，95% CI：1.229～3.406，P=0.007)、透析龄(OR=2.809，95% CI：1.524～5.179，P＜0.001)、N末端脑钠肽前体(NT-proBNP)(OR=3.572，95% CI：1.852～6.887，P＜0.001)、肌酸激酶同工酶(CK-MB)(OR=3.384，95% CI：1.786～6.411，P＜0.001)、血红蛋白(Hb)(OR=0.446，95% CI：0.256～0.777，P=0.005)、红细胞分布宽度(red blood cell distribution width，RDW)(OR=2.989，95% CI：1.603～5.575，P＜0.001)、血磷(OR=2.438，95% CI：1.359～4.371，P=0.003)、   C反应蛋白(CRP)(OR=3.174，95% CI：1.685～5.978，P＜0.001)、尿酸(UA)(OR=2.591，95% CI：1.419～4.729，P＜0.001)、降钙素原(procalcitonin，PCT)(OR=3.951，95% CI：2.021～7.724，P＜0.001)为维持性血液透析患者并发心力衰竭的影响因素。风险预测Nomogram模型中，模型组和验证组校准曲线与理想曲线一致性良好，一致性指数分别为0.836(95% CI：0.783～0.882)、0.827(95% CI：0.764～0.873)；预测模型组和验证组患者并发心力衰竭的AUC分别为0.842(95% CI：0.786～0.889)、0.835(95% CI：0.750～0.901)； 模型组和验证组阈概率分别在0～0.88、0～0.90时可获得净收益，说明该模型临床适用性良好。 结论  高血压、透析龄、NT-proBNP、CK-MB、Hb、RDW、血磷、CRP、UA、PCT为维持性血液透析患者并发心力衰竭的影响因素，由上述因素构建的Nomogram模型有良好的预测效能和适用性。

关键词: 维持性血液透析, 心力衰竭, 风险预测模型

Abstract: Objective  To construct a nomogram model for predicting the risk of heart failure in patients undergoing maintenance hemodialysis (MHD). Methods  The medical records of MHD patients at the Third People's Hospital of Henan Province from September 2020 to July 2023 were retrospectively analyzed. The patients were divided into a model group and a validation group in a 2:1 ratio. The model group was further categprized into concurrent group and non-concurrent group based on the occurrence of heart failure. Risk factors for heart failure was screened through Logistic regression analysis, and a risk prediction nomogram model was constructed and validated.  Results  A total of 312 patients were included, and they were including 208 in the model group and 104 in the validation group. Among the patients in the model group, 68 cases had concurrent heart failure (32.69%). Logistic regression analysis of the model group data showed that hypertension (OR=2.046, 95% CI: 1.229～3.406, P=0.007), dialysis age (OR=2.809, 95% CI: 1.524～5.179, P＜0.001), N-terminal pro-brain natriuretic peptide (NT-proBNP) (OR=3.572, 95% CI: 1.852～6.887, P＜0.001), creatine kinase isoenzyme (CK-MB) (OR=3.384, 95% CI: 1.786～6.411, P＜0.001), hemoglobin (Hb) (OR=0.446, 95% CI: 0.256～0.777, P=0.005), red cell volume distribution width (RDW) (OR=2.989, 95% CI: 1.603～5.575, P＜0.001), blood phosphorus (OR=2.438, 95% CI: 1.359～4.371, P=0.003), C-reactive protein (CRP) (OR=3.174, 95% CI: 1.685～5.978, P＜0.001), uric acid (UA) (OR=2.591, 95% CI: 1.419～4.729, P＜0.001) and procalcitonin (PCT) (OR=3.951, 95% CI: 2.021～7.724, P＜0.001) were all independent risk factors for heart failure in MHD patients. In the nomogram model, the calibration curves of the model group and validation group showed that the calibration curve of this model had good consistency with the ideal curve, and the consistency index of them were 0.836 (95% CI:0.783～0.882) and 0.827 (95% CI:0.764～0.873), respectively. The area under the curve for predicting heart failure in the model group and validation group were 0.843 (95% CI:0.786～0.889) and 0.835 (95% CI:0.750～0.901), respectively. The model group and the validation group could obtain net benefits when the threshold probability were 0～0.88 and 0～0.90.  Conclusion  Hypertension, dialysis vintage, NT-proBNP, CK-MB, hemoglobin, RDW, serum phosphorus, CRP, uric acid and PCT are independent risk factors for heart failure in MHD patients. The Nomogram model incorporating these factors exhibits strong predictive accuracy and clinical applicability.

Key words: Maintenance hemodialysis, Heart failure, Risk prediction model

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