建立并验证列线图模型预测心房颤动患者射频消融术后1年的复发风险
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R541.75

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Establish and validate a nomogram model to predict the risk of recur-rence one year after radiofrequency ablation in patients with atrial fibril-lation
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    摘要:

    目的:探讨心房颤动(AF)患者射频消融术(RFA)后1年的复发因素;构建预测模型并评估模型的临床性能。方法:纳入首次接受心脏射频消融术治疗的228例AF患者为研究对象,将患者分为开发集和验证集。对纳入的变量采用单因素及多因素Logistic回归分析确定RFA后复发的独立危险因素,利用R软件建立RFA后1年的复发影响因素列线图模型。分别通过一致性统计、校准图和决策曲线分析对模型进行验证和评价。结果:多因素Logistic回归分析显示房颤类型(OR=0.107,95%CI:0.034~0.299,P<0.001)、高血压(OR=2.844,95%CI:1.064~8.117,P=0.042)、亚临床甲状腺功能异常(OR=12.786,95%CI:2.063~86.374,P=0.007)、左心房直径(Left Atrial Diameter, LAD)(OR=1.178,95%CI:1.052~1.335,P=0.006)、脂蛋白(a)(Lipoprotein(a), Lp(a))(OR=1.002,95%CI:1.001~1.004,P=0.008)均是RFA1年后AF复发的独立危险因素;以此建立的列线图在开发集中预测RFA后1年AF复发的一致性指数为0.846(95%CI:0.785~0.905),验证集的一致性指数为0.744(95%CI:0.601~0.890),经1 000次bootstrap重复抽样对模型进行内部验证,校准曲线显示列线图预测结果与观察结果的吻合度较好,决策曲线分析提示列线图在开发集和验证集中均表现出良好的预测能力。结论:基于房颤类型、LAD、高血压、亚临床甲状腺功能异常及Lp(a)构建的列线图模型具有良好的辨别性和准确性,对RFA后1年的房颤复发具有一定的预测价值,有助于临床医生制定个体化患者的复发风险评估。

    Abstract:

    Objective:To investigate the factors associated with the recurrence of(atrial fibrillation,AF)1 year after(Ra-diofrequency ablation,RFA),and to construct a predictive model and evaluate its clinical performance.Methods:A total of 228 AF patients who were underwent their first cardiac RFA were included as the research subjects.The patients were divided into a development set and a validation set.Univariate and multivariate Logistic regression analyses were employed to identify inde-pendent risk factors for recurrence after RFA using the included variables.A nomogram model for predicting 1-year recurrence after RFA was constructed using R software.Finally,the model was validated and evaluated through concordance statistics,cali-bration plots,and decision curve analysis,respectively.Results:Multivariate Logistic regression analysis revealed that the type of atrial fibrillation(OR=0.107,95%CI:0.034~0.299,P<0.001),hypertension(OR=2.844,95%CI:1.064~8.117,P=0.042),subclinical thyroid dysfunction(OR=12.786,95%CI:2.063~86.374,P=0.007),Left Atrial Diameter(LAD,OR=1.178,95%CI:1.052~1.335,P=0.006),and Lipoprotein(a)[Lp(a),OR=1.002,95%CI:1.001~1.004,P=0.008]were all independent risk factors for AF recurrence 1 year after RFA.The nomogram developed based on these factors demonstrated a concordance index of 0.846(95%CI:0.785~0.905)in the development set for predicting AF recurrence 1 year after RFA,and a concordance index of 0.744(95%CI:0.601~0.890)in the validation set.Internal validation of the model through 1,000 bootstrap resampling showed that the calibration curve indicated a good agreement between the nomogram's predicted out-comes and the observed outcomes.Decision curve analysis suggested that the nomogram exhibited good predictive ability in both the development and validation sets.Conclusion:The nomogram model constructed based on atrial fibrillation type,LAD,hyper-tension,subclinical thyroid dysfunction,and Lp(a)demonstrates good discrimination and accuracy.It has certain predictive val-ue for atrial fibrillation recurrence one year after RFA,and aids clinicians in formulating individualized patient recurrence risk assessments.

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刘微;王玉兵;.建立并验证列线图模型预测心房颤动患者射频消融术后1年的复发风险[J].川北医学院学报,2025,40(11):1468-1475.

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  • 在线发布日期: 2025-12-22
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