老年高血压患者并发体位性低血压预测模型构建及验证-东南大学学报医学版

老年高血压患者并发体位性低血压预测模型构建及验证

单位：南京医科大学附属脑科医院心内科, 江苏南京 210046

分类号：R544.1

出版年·卷·期（页码）：2025·44·第二期（243-250）

摘要：

目的:探讨老年高血压患者并发体位性低血压(OH)的相关因素,建立预测模型并验证。方法:回顾性分析2022年10月至2024年10月本院收治的老年高血压患者的临床资料,从中纳入102例合并OH患者为OH组,并随机选择204例未合并OH患者为非OH组进行横断面研究。采集对比两组基线资料、疾病史、治疗用药等资料,单因素分析后应用最小绝对值收敛和选择算子(LASSO)回归进行变量筛选,多因素Logistic回归模型明确独立预测指标,建立Nomogram预测模型,并通过受试者工作特征(ROC)曲线、H-L检验与校准曲线、决策曲线与临床影响曲线评估模型区分度、校准度、临床受益。结果:OH组年龄、高血压病程及糖尿病、脑卒中、存在营养不良风险、应用α受体阻滞剂、利尿剂占比高于非OH组,体重指数低于非OH组(P＜0.05)。LASSO回归变量筛选获得年龄、体重指数、饮酒史、吸烟史、糖尿病、营养不良风险、应用α受体阻滞剂、高血压病程8个非零系数变量,多因素Logistic回归分析显示,年龄、营养不良风险、高血压病程为老年高血压合并OH的独立危险因素(P＜0.05)。ROC曲线分析显示,Nomogram预测模型预测老年高血压合并OH患者的曲线下面积(AUC)为0.748,截断阈值为0.294时,最佳预测敏感性为0.775,特异性为0.623,准确性为0.673。H-L检验显示, χ²＝5.212、P＝0.735,校准曲线中平均绝对误差为0.014。决策曲线显示,阈值概率在0.10~0.67范围,Nomogram预测模型临床收益较高;临床影响曲线进一步发现,阈值概率＞0.5时预测高风险患者例数与实际高风险患者例数一致性较高。结论:老年高血压合并OH的影响因素包括年龄、营养不良风险、高血压病程,且据此构建的Nomogram预测模型预测价值较好。

Objective: To investigate the risk factors for orthostatic hypotension(OH) in elderly hypertensive patients and to construct and validate a prediction model. Methods: Clinical data of elderly hypertensive patients from October 2022 to October 2024 were retrospectively analyzed. A cross-sectional study was conducted with 102 patients with OH(OH group) and 204 randomly selected patients without OH(non-OH group). Baseline characteristics, disease history, and medication information were collected. After univariate analysis, least absolute shrinkage and selection operator(LASSO) regression was used for variable selection, and multivariate Logistic regression identified independent predictors. A Nomogram prediction model was constructed and evaluated using receiver operating characteristic(ROC) curve,Hosmer-Lemeshow(H-L) test, calibration curve, decision curve, and clinical impact curve for discrimination, calibration, and clinical utility. Results: The OH group showed higher proportions of advanced age, diabetes, hypertension duration, stroke history, risk of malnutrition, use of alpha-receptor blockers and diuretics, and lower body mass index compared to the non-OH group(P<0.05). Through LASSO regression for variable screening, eight variables with non-zero coefficients were obtained: age, body mass index, drinking history, smoking history, diabetes, malnutrition risk, use of α-receptor blockers, and duration of hypertension. Multivariate Logistic regression confirmed age, risk of malnutrition, hypertension duration as independent risk factors for OH in elderly hypertensive patients(P<0.05). ROC curve analysis showed that the Nomogram prediction model had the area under the curve(AUC) of 0.748 for predicting elderly hypertensive patients with OH. At a cut-off value of 0.294, the optimal predictive sensitivity was 0.775, specificity was 0.623, and accuracy was 0.673. H-L test showed χ²=5.212, P=0.735, with mean absolute error of 0.014 on the calibration curve. Decision curve analysis indicated high clinical benefit within threshold probabilities of 0.10-0.67, and clinical impact curve showed high consistency between predicted and actual high-risk patients at threshold probability >0.5. Conclusion: Age, risk of malnutrition, and hypertension duration are significant factors affecting OH in elderly hypertensive patients, and the Nomogram prediction model based on these factors demonstrates good predictive value.

参考文献：

[1] DANI M,DIRKSEN A,TARABORRELLI P,et al.Orthostatic hypotension in older people: considerations,diagnosis and management[J].Clin Med(Lond),2021,21(3): e275-e282.
[2] WIELING W,KAUFMANN H,CLAYDON V E,et al.Diagnosis and treatment of orthostatic hypotension[J].Lancet Neurol,2022,21(8): 735-746.
[3] LIANG J,ZHANG W,PAN Y,et al.Associations between onset age of orthostatic hypotension and incident myocardial infarction,stroke,and dementia: a prospective cohort study[J].J Gerontol A Biol Sci Med Sci,2024,79(7): glae087.
[4] SAEDON N I,PIN TAN M,FRITH J.The prevalence of orthostatic hypotension: a systematic review and Meta-analysis[J].J Gerontol A Biol Sci Med Sci,2020,75(1): 117-122.
[5] WOJSZEL Z B,KASIUKIEWICZ A,MAGNUSZEWSKI L.Health and functional determinants of orthostatic hypotension in geriatric ward patients: a retrospective cross sectional cohort study[J].J Nutr Health Aging,2019,23(6): 509-517.
[6] JURASCHEK S P,BIAGGIONI I.Management of patients with hypertension and orthostatic hypotension[J].Hypertension,2022,79(11): 2385-2387.
[7] RABER I,BELANGER M J,FARAHMAND R,et al.Orthostatic hypotension in hypertensive adults: harry goldblatt award for early career investigators 2021[J].Hypertension,2022,79(11): 2388-2396.
[8] 中国高血压防治指南修订委员会,高血压联盟(中国),中华医学会心血管病学分会,等.中国高血压防治指南(2018年修订版)[J].中国心血管杂志,2019,24(1):24-56.
[9] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2020年版)[J].中华糖尿病杂志,2021,13(4):315-409.
[10] 中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中华全科医师杂志,2017,16(1):15-35.
[11] Global Initiative for Chronic Obstructive Lung Disease.Global strategy for the diagnosis,management and prevention of chronic obstructive pulmonary disease 2022 report[EB/OL].[2021-11-15].https://goldcopd.org/gold-reports/.
[12] 葛均波,徐永健.内科学[M].北京:人民卫生出版社,2013:473-474.
[13] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国各类主要脑血管病诊断要点2019[J].中华神经科杂志,2019,52(9):710-715.
[14] 周艳艳,马伟.NRS2002、MNA和MNA-SF评价老年患者营养状况[J].中国老年保健医学,2021,19(1):30-34.
[15] LAHRMANN H,CORTELLI P,HILZ M,et al.EFNS guidelines on the diagnosis and management of orthostatic hypotension[J].Eur J Neurol,2006,13(9): 930-936.
[16] HAILU W,TESFAYE T,DERSEH L,et al.Prevalence of orthostatic hypotension and associated factors among older people with hypertension in Northern Ethiopia[J].BMC Geriatr,2024,24(1): 928.
[17] VELTEN A P C,BENSEÑOR I,SOUZA J B,et al.Factors associated with orthostatic hypotension in adults: the ELSA-Brasil study[J].Cad Saude Publica,2019,35(8): e00123718.
[18] 方根强,胡燕,高艳虹.老年高血压患者体位性低血压的相关因素分析和干预措施[J].岭南心血管病杂志,2020,26(2):210-213.
[19] HUI G,XIAHUAN C,YANJUN W,et al.Influencing factors and hemodynamic study of initial and sustained orthostatic hypotension in middle-aged and elderly patients[J].J Clin Hypertens(Greenwich),2022,24(11): 1491-1497.
[20] 林立建,王国坤.体位性低血压与血压昼夜节律的相关性[J].中华高血压杂志,2022,30(10):980-984.
[21] GETU A A,ABUHAY D A,GOSHU B T.Orthostatic hypotension in male hypertensive patients: a cross-sectional study at the university of gondar comprehensive specialized hospital[J].Integr Blood Press Control,2021,14: 133-139.
[22] ZHANG Q,SHEN S,GUAN H,et al.Orthostatic hypotension is associated with malnutrition diagnosed by GLIM in elderly hypertensive patients[J].BMC Geriatr,2022,22(1): 866.
[23] 殷人易,谭子虎,柳弘汉,等.老年非神经源性体位性低血压与营养因素的相关性研究[J].中华老年心脑血管病杂志,2023,25(1):24-27.
[24] 韦晓洁,肖佳佳,李静,等.老年卧位高血压患者体位性低血压发生情况与营养状况的相关性[J].现代医学,2023,51(7):895-899.
[25] SASIDHARAN A,AMBATIPUDI S.A community-based cross-sectional survey of orthostatic hypotension among elderly from south India[J].Indian Heart J,2022,74(6): 478-483.
[26] 李雪,于雪,黄大海,等.老年高血压患者体位性低血压影响因素分析[J].中华老年医学杂志,2021,40(1):53-56.
[27] JURASCHEK S P,CORTEZ M M,FLACK J M,et al.Orthostatic hypotension in adults with gypertension: a scientific statement from the American Heart Association[J].Hypertension,2024,81(3): e16-e30.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录