心力衰竭患儿预后危险因素的多元Cox模型分析-现代医学

心力衰竭患儿预后危险因素的多元Cox模型分析

单位：南京医科大学附属儿童医院心血管内科, 江苏南京 210000

分类号：R725.4

出版年·卷·期（页码）：2024·52·第六期（910-915）

摘要：

目的： 探究心力衰竭(HF)患儿预后危险因素，为预后评定提供依据。方法： 回顾性分析2020年6月至2022年8月南京医科大学附属儿童医院107例HF患儿临床资料，依据患儿6个月预后情况分为预后不良组、预后良好组。采用Cox多因素回归分析确定HF患儿预后的影响因素；绘制受试者操作特征曲线(ROC)确定影响因素对患儿预后的预测价值。结果： 107例HF患儿中出现心血管事件死亡9例，由于HF加重再次住院20例，预后不良共29例(27.10%)，归为预后不良组；未出现心血管事件死亡且未出现HF加重再次住院78例(72.90%)，归为预后良好组。Cox多因素回归分析显示，改良ROSS评分与B型利钠肽(BNP)、红细胞分布宽度(RDW)、超敏-C反应蛋白(hs-CRP)均为HF患儿预后不良的危险因素，白蛋白(ALB)、血清钠(Na⁺)为保护因素(P＜0.05)。绘制ROC曲线显示，改良ROSS评分与BNP、RDW、hs-CRP、ALB、Na⁺均对HF患儿预后不良有一定预测效力，AUC分别为0.795、0.848、0.705、0.830、0.729、0.754。结论： HF患儿预后影响因素包括改良ROSS评分、BNP、RDW、hs-CRP、ALB、Na⁺，对预后预测价值良好。

Objective: To explore the prognostic risk factors of children with heart failure(HF), and to provide a basis for prognosis evaluation. Methods: The clinical data of 107 children with HF admitted to the Nanjing Children's Hospital from June 2020 to August 2022 were retrospectively collected. According to the prognosis of 6 months, the children were divided into poor prognosis group and good prognosis group. Cox multivariate regression analysis was used to determine the influencing factors for the prognosis in children with HF. Receiver operating characteristic curve(ROC) was drawn to determine the predictive value of influencing factors for the prognosis of children. Results: Among 107 children with HF, 9 cases died of cardiovascular events, 20 cases were hospitalized again due to HF aggravation, 29 cases(27.10%) had poor prognosis, who were classified into poor prognosis group; there were 78 cases(72.90%) of rehospitalization without cardiovascular event death and HF aggravation, who were classified into good prognosis group. Cox multivariate regression analysis showed that the modified ROSS score, b-type natriuretic peptide(BNP), red blood cell distribution width(RDW), high-sensitivity C-reactive protein(hs-CRP) were risk factors for poor prognosis in children with HF, and albumin(ALB), serum natrium(Na⁺) were protective factors(P<0.05). The ROC curve showed that the improved ROSS score and BNP, RDW, hs-CRP, ALB, Na⁺ had a certain predictive effect on the poor prognosis of children with HF, and the AUC was 0.795, 0.848, 0.705, 0.830, 0.729 and 0.754, respectively. Conclusion: The prognostic factors of children with HF include modified ROSS score, BNP, RDW, hs-CRP, ALB and Na⁺, which have good predictive value for prognosis.

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