基于NHANES数据库探索HALP评分与心肌梗死患者死亡率的关系OA
Exploring the relationship between the HALP score and mortality in patients with myocardial infarction based on the NHANES database
目的 评估血红蛋白、白蛋白、淋巴细胞和血小板(HALP)评分与心肌梗死(MI)患者预后的关系.方法 基于1999-2018年美国国家健康与营养调查数据,筛选MI患者,并根据HALP评分的四分位数将其分为Q1至Q4四组.采用Schoenfeld残差法检验变量等比例风险假设,构建未调整、调整人口统计学变量、调整全协变量三层加权Cox比例风险模型,分析HALP评分与全因死亡率的关联并开展亚组分析;运用限制性立方样条回归验证二者潜在非线性关系,存在显著非线性关联时采用基于阈值分析的两分段线性回归,并结合Kaplan-Meier(K-M)曲线比较不同HALP评分组的生存差异.结果 纳入2 131例MI患者,中位随访时间80个月,按HALP四分位数分组,组间在年龄、性别、种族、婚姻状况等方面有显著差异(P<0.05).K-M曲线显示,随随访时间增长各评分组生存率均呈下降趋势;整体而言,Q1组生存率最低,Q3组相对较高,Q4组长期生存率较Q3组略低.HALP评分与全因死亡率呈J型非线性关联,转折点为78.53.Cox回归分析显示,调整全协变量后,HALP评分在转折点前与死亡风险负相关,每增加1单位死亡风险降低0.8％,超转折点后,HALP评分与死亡风险的关联趋于平缓,保护效应未进一步增强.亚组分析发现,HALP评分与种族存在交互作用,其他种族群体中HALP保护效应更强.结论 本研究证实HALP评分与MI患者全因死亡率呈J型非线性关联,低于阈值时HALP评分越高死亡风险越低.
Objective To evaluate the association between the hemoglobin,albumin,lymphocyte,and platelet(HALP)score and the prognosis of patients with myocardial infarction(MI).Methods Using data from the National Health and Nutrition Examination Survey of the United States from 1999 to 2018,patients with MI were identified and divided into four groups(Q1 to Q4)based on the quartiles of their HALP scores.The Schoenfeld residual method was used to test proportional hazards assumption.Three-tiered weighted Cox proportional hazards models were constructed:unadjusted,adjusted for demographic variables,and adjusted for all covariates.These models analyzed the association between HALP scores and all-cause mortality,with subgroup analyses performed.Restricted cubic spline regression was employed to validate potential nonlinear relationships.When significant nonlinearity was detected,two-stage linear regression based on threshold analysis was applied.Kaplan-Meier(K-M)curves were used to compare survival differences across HALP score groups.Results A total of 2,131 patients were enrolled with a median follow-up of 80 months.Significant differences were observed among the four groups in terms of age,sex,race,marital status,and other variables(P<0.05).The K-M curve showed that survival rates in all scoring groups declined as the follow-up period increased;overall,the Q1 group had the lowest survival rate,the Q3 group had a relatively higher rate,and the long-term survival rate in the Q4 group was slightly lower than that in the Q3 group.HALP scores exhibited a J-shaped nonlinear association with all-cause mortality,with a turning point at 78.53.Cox regression analysis revealed that,after adjusting for covariates,HALP scores were negatively associated with mortality risk below the turning point,with each 1-unit increase corresponding to a 0.8％reduction in mortality risk.Beyond the turning point,the association between HALP score and mortality risk tended to plateaued,and the protective effect did not further increase.Subgroup analysis revealed an interaction between HALP score and race,with stronger protective effect observed in the other race group.Conclusion This study confirms a J-shaped nonlinear association between HALP score and all-cause mortality in MI patients,where higher scores associated with lower mortality risk below the threshold.
欧阳吉;胡志希
湖南中医药大学中医学院(长沙 410208)湖南中医药大学中医学院(长沙 410208)
医药卫生
心肌梗死血红蛋白、白蛋白、淋巴细胞和血小板评分亚组分析
Myocardial infarctionHemoglobin,albumin,lymphocyte,and platelet scoreSubgroup analysis
《医学新知》 2026 (5)
519-526,8
国家自然科学基金面上项目(82574922、82274412)
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