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老年糖尿病肾病维持性血液透析患者并发心脏瓣膜钙化的影响因素分析及列线图预测模型构建

Influencing factors and construction of a nomogram prediction model for cardiac valve calcification in elderly patients with diabetic nephropathy undergoing maintenance hemodialysis

    摘要
  • 摘要:
    目的 分析老年糖尿病肾病维持性血液透析患者并发心脏瓣膜钙化(CVC)的影响因素，构建并验证列线图预测模型。
    方法 选取280例接受维持性血液透析治疗的老年糖尿病肾病患者作为研究对象，根据是否发生CVC分为CVC组和非CVC组。比较2组患者的临床资料，采用最小绝对收缩和选择算子(LASSO)-Logistic回归分析筛选患者发生CVC的影响因素，据此构建列线图预测模型并验证其预测效能。
    结果 280例患者中, 91例发生CVC, 发生率为32.50%; CVC组患者年龄、透析龄、继发性甲状旁腺功能亢进者占比、瓣膜关闭不全者占比、左心室肥厚者占比、收缩压、钙磷乘积及血清成纤维细胞生长因子23(FGF23)、可溶性生长刺激表达基因2蛋白(sST2)、视黄醇结合蛋白(RBP)、长正五聚蛋白3(PTX3)水平高于非CVC组，低密度脂蛋白、Klotho水平低于非CVC组，差异有统计学意义(P＜0.05); LASSO-Logistic回归分析显示，年龄、继发性甲状旁腺功能亢进、钙磷乘积及血清FGF23、Klotho、sST2、RBP、PTX3水平是老年糖尿病肾病维持性血液透析患者发生CVC的独立影响因素(P＜0.05); 基于独立影响因素构建列线图预测模型，受试者工作特征(ROC)曲线、校准曲线显示该模型具有良好的区分度、准确度和预测效能。
    结论 年龄、继发性甲状旁腺功能亢进、钙磷乘积及血清FGF23、Klotho、sST2、RBP、PTX3水平是老年糖尿病肾病维持性血液透析患者发生CVC的独立影响因素，据此构建的列线图预测模型具有较高的区分度、准确度和预测效能。

     

    Abstract:
    Objective To analyze the influencing factors of cardiac valve calcification (CVC) in elderly patients with diabetic nephropathy undergoing maintenance hemodialysis and to construct and validate a nomogram prediction model.
    Methods A total of 280 elderly patients with diabetic nephropathy undergoing maintenance hemodialysis were selected as study subjects and divided into CVC group and non-CVC group based on the occurrence of CVC. Clinical data of the two groups were compared. The least absolute shrinkage and selection operator (LASSO)-Logistic regression analysis was used to screen the influencing factors of CVC occurrence in patients. A nomogram prediction model was constructed based on these factors and its predictive performance was validated.
    Results Among 280 patients, 91 developed CVC, with an incidence rate of 32.50%. Patients in the CVC group had higher age, dialysis vintage, proportion of secondary hyperparathyroidism, proportion of valvular insufficiency, proportion of left ventricular hypertrophy, systolic blood pressure, calcium-phosphorus product, and serum levels of fibroblast growth factor 23 (FGF23), soluble growth stimulation expressed gene 2protein (sST2), retinol-binding protein (RBP), and pentraxin 3 (PTX3) compared to the non-CVC group. In contrast, low-density lipoprotein and Klotho levels were lower in the CVC group (P < 0.05). LASSO-Logistic regression analysis revealed that age, secondary hyperparathyroidism, calcium-phosphorus product, and serum levels of FGF23, Klotho, sST2, RBP, and PTX3 were independent influencing factors for CVC occurrence in elderly patients with diabetic nephropathy undergoing maintenance hemodialysis (P < 0.05). A nomogram prediction model was constructed based on these independent influencing factors. The receiver operating characteristic (ROC) curve and calibration curve demonstrated that the model had good discrimination, accuracy, and predictive performance.
    Conclusion Age, secondary hyperparathyroidism, calcium-phosphorus product, and serum levels of FGF23, Klotho, sST2, RBP, and PTX3 are independent influencing factors for CVC occurrence in elderly patients with diabetic nephropathy undergoing maintenance hemodialysis. The nomogram prediction model constructed based on these factors exhibits high discrimination, accuracy, and predictive performance.

     

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