冠心病合并慢性心力衰竭患者不同结局的零膨胀联合脆弱模型

李靓; 田晶; 闫晶晶; 任嘉; 韩清华; 张岩波

doi:10.16462/j.cnki.zhjbkz.2021.08.016

冠心病合并慢性心力衰竭患者不同结局的零膨胀联合脆弱模型

doi: 10.16462/j.cnki.zhjbkz.2021.08.016

李靓^{1, 2},
田晶³,
闫晶晶^{1, 2},
任嘉³,
韩清华^3, ,,
张岩波^{1, 2, ,}

1.
030000 太原，山西医科大学公共卫生学院卫生统计学教研室
2.
030000 太原，重大疾病风险评估山西省重点实验室
3.
030000 太原，山西医科大学第一附属医院心内科

基金项目:

国家自然科学基金 81872714

山西省重点实验室 201805D111006

详细信息

通讯作者:
韩清华，E-mail: syhqh@sohu.com

张岩波，E-mail: sxmuzyb@126.com

中图分类号: R181.2;R541
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- 文章访问数: 319
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- 被引次数: 0
出版历程
- 收稿日期: 2020-12-09
- 修回日期: 2021-02-27
- 网络出版日期: 2021-08-24
- 刊出日期: 2021-08-10

Joint frailty models for zero-inflated analysis of different outcomes in patients with coronary heart disease complicated with chronic heart failure

LI Jing^{1, 2},
TIAN Jing³,
YAN Jing-jing^{1, 2},
REN Jia³,
HAN Qing-hua^{3
, ,},
ZHANG Yan-bo^{1, 2
, ,}

1.
Department of Biostatistics, School of Public Health, Shanxi Medical University, Taiyuan 030000, China
2.
Department of Cardiology, First Affiliated Hospital, Shanxi Medical University, Taiyuan 030000, China
3.
Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan 030000, China

Funds:

National Natural Science Foundation of China 81872714

Shanxi Provincial Key Laboratory 201805D111006

More Information

Corresponding author: HAN Qing-hua, E-mail: syhqh@sohu.com; ZHANG Yan-bo, E-mail: sxmuzyb@126.com

摘要

摘要: 目的建立零膨胀联合脆弱模型探讨冠状动脉粥样硬化性心脏病(简称冠心病)合并慢性心力衰竭患者不同结局的影响因素，降低患者不良结局的发生。方法选取2014-2015年两所三级甲等医院冠心病合并慢性心力衰竭患者，收集患者住院期间的电子病历信息以及随访信息，建立零膨胀联合脆弱模型进行影响因素分析。结果本研究共纳入患者2 221例，1 312例患者未发生任何事件(59.07%)，699例患者再住院(31.47%)，307例患者死亡(13.82%)。性别、职业、BMI是冠心病合并慢性心力衰竭患者不同结局的共同影响因素，陈旧性心肌梗死、QRS间期延长是减少患者未再住院的可能性的影响因素；高龄、美国纽约心脏病协会(New York heart association, NYHA)心功能分级≥Ⅲ级、心脏瓣膜病是患者再住院与死亡的危险因素，增加再住院与死亡风险；QRS间期延长和心房颤动是患者死亡的危险因素，冠脉搭桥为保护性因素，降低患者死亡风险。结论零膨胀联合脆弱模型可同时分析冠心病合并慢性心力衰竭患者未再住院、再住院及死亡的影响因素，为高危患者识别、干预和治疗提供理论依据。
- 慢性心力衰竭 /
- 再住院 /
- 死亡 /
- 零膨胀联合脆弱模型
Abstract: Objective Joint frailty models for zero-inflated was established to explore the influential factors of different outcomes for patients with coronary heart disease complicated with chronic heart failure to reduce the incidence of adverse outcomes. Methods The sample includes patients with coronary heart disease complicated with chronic heart failure in two tertiary hospitals of Shanxi Province from 2014 to 2015. The electronic medical record information of patients during hospitalization and their follow-up information were collected, and joint frailty models for zero-inflated was established to analyze the influential factors. Results A total of 2 221 patients were included in this study. 1 312 patients had no incident (59.07%), 669 patients were re-hospitalized (31.47%) and 307 patients died (13.82%). Gender, occupation and BMI were common influential factors for different outcomes of patients with coronary heart disease complicated with chronic heart failure. Old myocardial infarction and prolonged QRS interval were influential factors to reduce the possibility of patients not being hospitalized again. Advanced age, NYHA grade ≥ Ⅲ and valvular disease were risk factors for rehospitalization and death. Prolonged QRS interval was a risk factor of death; on the contrary, coronary artery bypass grafting was a protective factor to reduce mortality. Conclusions Joint frailty models for zero-inflated can analyze the influential factors of non-rehospitalization, rehospitalization and death for patients with coronary heart disease complicated with chronic heart failure simultaneously, and provide a theoretical reference for the identification, intervention and treatment of high-risk patients.
- Chronic heart failure /
- Rehospitalization /
- Death /
- Joint frailty models for zero-inflated

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表 1 CHD合并CHF患者再住院情况

Table 1. The situation of re-hospitalization of patients with coronary heart disease complicated with chronic heart failure

住院次数	频数
1	418
2	140
3	79
4	24
5	13
6	25

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表 2 CHD合并CHF患者再住院和死亡的基本资料比较[n (%)]

Table 2. Comparison of basic data of rehospitalization and death in patients with coronary heart disease complicated with chronic heart failure [n (%)]

基本情况	住院(n=2 221)	再住院(n=699)	P值	死亡(n=307)	P值	基本情况	住院(n=2 221)	再住院(n=699)	P值	死亡(n=307)	P值
年龄(岁)			< 0.001		< 0.001	陈旧性心肌梗死			< 0.001		0.005
< 45	12(0.54)	2(16.67)		1(8.33)		无	1 206(54.30)	299(24.79)		144(11.94)
45~ < 60	235(10.58)	56(23.83)		5(2.13)		有	1 015(45.70)	400(39.41)		163(16.06)
60~ < 75	904(40.70)	228(25.22)		75(8.30)		心房颤动			< 0.001		< 0.001
75~ < 90	959(43.18)	370(38.58)		180(18.77)		无	1 776(79.96)	491(27.65)		214(12.05)
≥90	111(5.00)	43(38.74)		46(41.44)		有	445(20.04)	208(46.74)		93(20.90)
职业			< 0.001		< 0.001	高血压			0.087		0.284
体力	1 514(68.17)	538(35.54)		241(15.92)		无	791(35.61)	231(29.20)		101(12.77)
非体力	707(31.83)	161(22.77)		66(9.34)		有	1 430(64.39)	468(32.73)		206(14.41)
医保类型			< 0.001		< 0.001	心脏瓣膜病			0.030		0.002
市医保	1 610(72.49)	578(35.90)		257(15.96)		无	2 083(93.79)	667(32.02)		276(13.25)
新农合	611(27.51)	121(19.80)		50(8.18)		有	138(6.21)	32(23.19)		31(22.46)
NYHA心功能分级			< 0.001		< 0.001	恶性肿瘤			0.650		0.105
Ⅱ	927(41.74)	205(22.11)		58(6.26)		无	2 192(98.69)	691(31.52)		300(13.69)
Ⅲ	971(43.72)	380(39.13)		142(14.62)		有	29(1.31)	8(27.59)		7(24.14)
Ⅳ	323(14.54)	114(35.29)		107(33.13)		QRS间期延长			0.014		< 0.001
BMI(kg/m²)			0.966		< 0.001	无(≤120 s)	1 894(85.28)	577(82.55)		229(74.60)
< 18.5	87(3.92)	29(4.15)		27(8.79)		有(>120 s)	327(14.72)	122(17.45)		78(25.40)
18.5~ < 24.0	821(36.97)	260(31.67)		133(43.32)		冠脉搭桥			0.614		0.004
24.0~ < 28.0	910(40.97)	282(37.20)		106(34.53)		无	1 936(87.17)	613(97.70)		284(92.51)
≥28.0	403(18.14)	128(18.31)		41(13.36)		有	285(12.83)	86(2.30)		23(7.49)
家族史			0.725		0.063
无	1 874(84.38)	587(31.32)		270(14.41)
有	347(15.62)	112(32.28)		37(10.66)

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表 3 CHD合并CHF患者未再住院、再住院、死亡影响因素的零膨胀联合脆弱模型

Table 3. Joint frailty models for zero-inflated of influencing factors of non-rehospitalization, rehospitalization and death in patients with coronary heart disease complicated with chronic heart failure

参数	Est值	s_x值	P值	OR/HR值	Est的95% CI值
参数	Est值	s_x值	P值	OR/HR值	上限值	下限值
Logistic回归分析模型
截距	0.136	0.794	0.864		-1.422	1.694
性别	-0.745	0.134	< 0.001	0.475	-1.008	-0.482
年龄	0.034	0.117	0.769	1.035	-0.195	0.264
职业	2.500	0.154	< 0.001	12.181	2.197	2.803
NYHA心功能分级	-0.001	0.086	0.991	0.999	-0.171	0.169
BMI	0.772	0.090	< 0.001	2.163	0.595	0.949
陈旧性心肌梗死	-0.250	0.124	0.044	0.779	-0.493	-0.007
心房颤动	-0.058	0.145	0.686	0.943	-0.342	0.225
心脏瓣膜病	0.030	0.223	0.894	1.030	-0.407	0.466
QRS间期延长	-0.693	0.161	< 0.001	0.500	-1.008	-0.378
冠脉搭桥	-0.090	0.175	0.609	0.914	-0.433	0.254
再住院
性别	0.532	0.131	< 0.001	1.703	0.276	0.789
年龄	0.214	0.069	0.002	1.239	0.079	0.349
职业	-0.599	0.122	< 0.001	0.550	-0.838	-0.359
NYHA心功能分级	0.352	0.079	< 0.001	1.422	0.197	0.508
BMI	-2.227	0.061	< 0.001	0.108	-2.348	-2.107
陈旧性心肌梗死	0.023	0.111	0.833	1.024	-0.195	0.242
心房颤动	0.033	0.105	0.752	1.034	-0.173	0.240
心脏瓣膜病	0.844	0.213	< 0.001	2.326	0.427	1.261
QRS间期延长	0.082	0.152	0.588	1.086	-0.216	0.380
冠脉搭桥	-0.157	0.145	0.277	0.855	-0.440	0.126
θ	0.979	0.002	< 0.001		0.975	0.983
死亡
性别	0.815	0.128	< 0.001	2.259	0.564	1.066
年龄	0.305	0.088	0.001	1.357	0.132	0.478
职业	-1.307	0.168	< 0.001	0.271	-1.637	-0.978
NYHA心功能分级	0.356	0.081	< 0.001	1.428	0.197	0.515
BMI	-0.251	0.073	0.001	0.778	-0.393	-0.108
陈旧性心肌梗死	0.028	0.122	0.818	1.029	-0.212	0.268
心房颤动	0.333	0.134	0.013	1.396	0.071	0.596
心脏瓣膜病	0.640	0.193	0.001	1.897	0.262	1.019
QRS间期延长	1.384	0.139	< 0.001	3.992	1.112	1.657
冠脉搭桥	-4.351	0.474	< 0.001	0.013	-5.281	-3.421

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冠心病合并慢性心力衰竭患者不同结局的零膨胀联合脆弱模型

doi: 10.16462/j.cnki.zhjbkz.2021.08.016

通讯作者:
韩清华，E-mail: syhqh@sohu.com

张岩波，E-mail: sxmuzyb@126.com

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Joint frailty models for zero-inflated analysis of different outcomes in patients with coronary heart disease complicated with chronic heart failure

Corresponding author: HAN Qing-hua, E-mail: syhqh@sohu.com; ZHANG Yan-bo, E-mail: sxmuzyb@126.com

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冠心病合并慢性心力衰竭患者不同结局的零膨胀联合脆弱模型

doi: 10.16462/j.cnki.zhjbkz.2021.08.016

通讯作者: 韩清华，E-mail: syhqh@sohu.com 张岩波，E-mail: sxmuzyb@126.com

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Joint frailty models for zero-inflated analysis of different outcomes in patients with coronary heart disease complicated with chronic heart failure

Corresponding author: HAN Qing-hua, E-mail: syhqh@sohu.com; ZHANG Yan-bo, E-mail: sxmuzyb@126.com

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通讯作者:
韩清华，E-mail: syhqh@sohu.com

张岩波，E-mail: sxmuzyb@126.com