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[动脉僵硬度评估对高龄老年人血管僵硬度风险预测的临床价值]

[Clinical value of arterial stiffness assessment on risk prediction of vascular stiffness in the octogenarian elderly].

作者信息

Wang Y J, Gu Z H, Wu X P, Fang Z Y, Wang T H, Gao S, Yang X, Shen X Y, Zhou T Y, Zhang Q, Li J X, Cao F

机构信息

Medical School of Chinese People's Liberation Army General Hospital, Beijing 100853, China.

Second Medical Center of Chinese People's Liberation Army General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing 100853, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2023 Oct 24;51(10):1069-1074. doi: 10.3760/cma.j.cn112148-20230530-00316.

Abstract

This study aimed to analyze clinical factors related to arterial stiffening and establish a risk prediction nomogram of arterial stiffening in the octogenarian(≥80 years). This study was a retrospective cross-sectional study, which enrolled the octogenarian elderly who underwent physical examination and secondary prevention intervention in the outpatient department of Chinese People's Liberation Army General Hospital from April 2022 to August 2022. Clinical data including demographics, biochemical indicators and medical history were collected. Brachial-ankle pulse wave velocity (baPWV) was detected during the clinical visit. Participants were divided into the control group (baPWV≤1 800 cm/s) and vascular sclerosis group (baPWV>1 800 cm/s). The risk factors of arterial stiffness were analyzed by univariate and logistic regression analysis, and the nomogram model was constructed by R programming language. The predictive effect of the nomogram model was evaluated by the receiver operating characteristic curve (ROC). The median age of the 525 participants was 87.0 (82.0, 92.0) years, 504 (96.0%) were male, 82 in the control group, 443 in the vascular sclerosis group. The baPWV, age, systolic blood pressure, mean arterial pressure and diastolic blood pressure were significantly lower in the control group than those in the vascular sclerosis group (all <0.05). Logistic regression analysis showed that high-density lipoprotein cholesterol, alanine aminotransferase and amylase were protective factors, and alkaline phosphatase and creatinine were risk factors of arterial stiffening (all <0.05). The combined nomogram model scores including age, mean arterial pressure and the above five laboratory indicators indicated that mean arterial pressure and serum creatinine levels were strongly correlated with vascular sclerosis. The ROC curve suggested that the nomogram model had good prediction ability. Age, mean arterial pressure, high-density lipoprotein cholesterol, alanine aminotransferase, alkaline phosphatase, amylase and creatinine are independently determinants for increased vascular stiffness. The combined prediction model in this study can provide reference for individualized clinical risk prediction of vascular sclerosis in the octogenarian elderly.

摘要

本研究旨在分析与动脉僵硬度相关的临床因素,并建立八旬老人(≥80岁)动脉僵硬度的风险预测列线图。本研究为回顾性横断面研究,纳入了2022年4月至2022年8月在中国人民解放军总医院门诊部接受体检及二级预防干预的八旬老人。收集了包括人口统计学、生化指标和病史在内的临床资料。在临床就诊期间检测臂踝脉搏波速度(baPWV)。参与者被分为对照组(baPWV≤1800 cm/s)和血管硬化组(baPWV>1800 cm/s)。通过单因素和逻辑回归分析动脉僵硬度的危险因素,并使用R编程语言构建列线图模型。通过受试者工作特征曲线(ROC)评估列线图模型的预测效果。525名参与者的中位年龄为87.0(82.0,92.0)岁,男性504名(96.0%),对照组82名,血管硬化组443名。对照组的baPWV、年龄、收缩压、平均动脉压和舒张压均显著低于血管硬化组(均<0.05)。逻辑回归分析显示,高密度脂蛋白胆固醇、丙氨酸氨基转移酶和淀粉酶是保护因素,碱性磷酸酶和肌酐是动脉僵硬度的危险因素(均<0.05)。包括年龄、平均动脉压和上述五项实验室指标的联合列线图模型评分表明,平均动脉压和血清肌酐水平与血管硬化密切相关。ROC曲线表明列线图模型具有良好的预测能力。年龄、平均动脉压、高密度脂蛋白胆固醇、丙氨酸氨基转移酶、碱性磷酸酶、淀粉酶和肌酐是血管僵硬度增加的独立决定因素。本研究中的联合预测模型可为八旬老人血管硬化的个体化临床风险预测提供参考。

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