慢性心力衰竭患者圆锥度指数与全因死亡率的关系：一项基于NHANES纵向队列研究-现代医学

慢性心力衰竭患者圆锥度指数与全因死亡率的关系：一项基于NHANES纵向队列研究

单位：新疆医科大学第一附属医院心力衰竭科, 新疆乌鲁木齐 830054

分类号：R541.6

出版年·卷·期（页码）：2026·54·第二期（240-249）

摘要：

目的： 探讨慢性心力衰竭(HF)患者圆锥度指(C-index)与全因死亡率之间的关系。方法： 本研究基于美国国家健康与营养调查(NHANES)2001—2018年的数据进行分析，根据纳排标准，最终共纳入1 225例HF患者，随访至2019年12月31日，按C-index三分位数法将HF患者分为T1、T2和T3 3组，比较3组的基线资料，基于NHANES推荐的权重，采用加权Cox比例风险回归逐步调整协变量，构建3个回归模型(不调整协变量，部分调整协变量及完全调整协变量)，使用Kaplan-Meier生存曲线、Cox回归探究HF患者C-index与全因死亡率之间的关系，并进行加权趋势性分析。构建限制性立方样条(RCS)曲线评估其与全因死亡率的剂量-反应关系。利用受试者工作特征(ROC)曲线来评估C-index、身体质量指数(BMI)与腰围和全因死亡率的关系。采用亚组分析探讨C-index与不同特征患者全因死亡风险的关系，并进行敏感性分析验证模型的稳定性。结果： 在中位随访108.60个月期间，共有586例HF患者发生死亡。在完全调整协变量后的加权Cox回归模型中，C-index每增加1个标准差，HF患者全因死亡风险增加10%(HR=1.10,95%CI 1.01～1.20)，与T1组相比，较高的C-index与HF患者全因死亡风险增加有关(HR=1.26,95%CI 1.02～1.55)；趋势性分析显示，与T1组相比，T3组的各个模型均显示C-index升高会导致HF患者全因死亡风险升高(P_趋势<0.001)；RCS分析证实，C-index与全因死亡率之间存在线性关联(P_整体=0.006，P_非线性=0.983)；ROC曲线下面积表明，与BMI和腰围相比，C-index与全因死亡风险的关联更为显著。亚组分析显示，吸烟史与C-index存在交互作用(P_交互作用=0.016)；敏感性分析进一步证实了本研究主要结果的稳健性。结论： HF患者的C-index与全因死亡风险之间存在线性关系，较高的C-index与全因死亡风险增加有关，和BMI和腰围相比，C-index与全因死亡风险的关联更为显著。

Objective: To investigate the association between the conicity index(C-index) and all-cause mortality in patients with chronic heart failure(HF). Methods: This cross-sectional analysis utilized data from the National Health and Nutrition Examination Survey(NHANES) from 2001 to 2018. According to inclusion and exclusion criteria, a total of 1 225 HF patients were ultimately included and followed up until December 31, 2019. Participants were divided into T1, T2, and T3 groups based on C-index tertiles. Baseline characteristics were compared among the three groups. Using NHANES-recommended weights, multivariate weighted Cox proportional hazards regression models were employed, progressively adjusting for covariates to construct three models(unadjusted, partially adjusted, and fully adjusted models). Kaplan-Meier survival curves and multivariate weighted Cox regression were used to examine the relationship between C-index and all-cause mortality in HF patients, alongside a weighted trend analysis. Restricted cubic spline(RCS) plots were constructed to assess the dose-response relationship with all-cause mortality. The receiver operating characteristic(ROC) curve was utilized to evaluate the relationship of C-index, body mass index(BMI) and waist circumference(WC) with all-cause mortality. Subgroup analysis was performed to explore the association between C-index and all-cause mortality in patients with different characteristics, and sensitivity analysis was conducted to verify model stability. Results: During a median follow-up of 108.60 months, 586 all-cause deaths occurred among the HF patients. In the fully adjusted weighted Cox proportional hazards model, for each standard deviation increase in C-index, the risk of all-cause mortality in HF patients increased by 10%(HR=1.10,95%CI 1.01-1.20). Compared to T1 group, a higher C-index was associated with an increased risk of all-cause mortality(HR=1.26,95%CI 1.02-1.55). Trend analysis showed that compared to the T1 group, all models in the T3 group indicated that an increase in C-index led to an increased risk of all-cause mortality in HF patients(P_{for trend}<0.001). RCS analysis confirmed a linear association between C-index and all-cause mortality(P_overall=0.006, P_nonlinear=0.983). The area under the ROC curve indicates that C-index has a more significant association with all-cause mortality risk compared to BMI and WC. Subgroup analysis indicated an interaction between smoking history and C-index(P_{for interaction} =0.016). Sensitivity analysis results were consistent with the main findings. Conclusion: A linear relationship exists between C-index and all-cause mortality in HF patients. C-index is an independent risk factor for increased all-cause mortality in HF patients. Compared to BMI and WC, C-index shows a more significant association with all-cause mortality risk in HF patients.

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