Development And Validation A Nomogram For COPD Complicated With Chronic Cor Pulmonale And Distribution Of TCM Syndrome Analyze

Research purpose:Based on clinical data,establish and validate the prognostic prediction model of COPD（chronic obstructive pulmonary disease）complicated with CCP（chronic cor pulmonale）,explore the Traditional Chinese Medicine（TCM）main symptoms and syndromes.Research methods:COPD patients were selected from the First teaching hospital of Tianjin University of TCM between Jan 2018 to June 2021.They were randomly separated into the training set and validation set based on the ratio of 7:3.Logistic regression analysis was used to select variables for the nomogram.The discrimination and calibration of the nomogram were evaluated using the area under receiver operating characteristic curve（AUC）,bootstrap,calibration plots,and decision curve analysis（DCA）.For analyzing the distribution of TCM syndromes,patients were divided into 2 groups according to whether complicated with CCP,compared main symptoms,tongue and pulse diagnosis,and TCM syndromes by chi-square test.Research results:Overall,290 and 125 cases were divided into a training set and validation set.In the training set,there were 199 and 91cases were COPD and COPD-CCP;96 and 29 cases in the validation set,respectively.After univariate logistic regression analysis found that gender,GOLD grade,FEV₁/FVC,BMI≥25kg/m²,emphysema,ischemic heart disease,arrhythmia,hypoxemia,hypercapnia,Pa CO₂,Sa O₂,Pa O₂,albumin（ALB）,lactate dehydrogenase（LDH）,andα-HBDH were the risk factors of COPD-CCP.Finally,7 variables were selected to establish the nomogram for COPD-CCP after multi-collinearity test and multivariate logistic analysis（Forward LR）:FEV₁/FVC（OR:0.96,95%CI:0.94-0.98,P=0.003）,BMI≥25kg/m²（OR:4.01,95%CI:2.13-7.55,P<0.001）,emphysema（OR:2.69,95%CI:1.32-5.49,P=0.007）,Pa CO₂（OR:1.03,95%CI:1.00-1.06,P=0.006）,Sa O₂（OR:0.91,95%CI:0.84-0.99,P=0.022）,ALB（OR:0.91,95%CI:0.84-0.98,P=0.019）,α-HBDH（OR:1.01,95%CI:1.00-1.02,P=0.004）.The prediction model equation=Logit（P）=9.216-0.04（FEV₁/FVC）+1.389（BMI≥25kg/m²）+0.989（emphysema）+0.029（Pa CO₂）-0.094（Sa O₂）-0.093（ALB）+0.013（α-HBDH）.Hosmer-Lemeshoz test showedc²=3.765（P=0.878>0.05）,the AUC（0.814,95%CI:0.76-0.87,P<0.001 for the training set and 0.756,95%CI:0.65-0.86,P<0.001 for the validation set）,and DCA showed that the nomogram was clinically useful.In aim at exploring the TCM syndromes and main symptoms,a total of 415 patients,295in COPD and 120 in COPD-CCP.For TCM main symptoms,compared with COPD there was a statistical difference in palpitation and peripheral edema（COPD vs.COPD-CCP,P<0.05）,except for phlegm color,complexion,and fear of cold（P>0.05）.And in TCM tongue and pulse diagnosis,the proportion of white greasy tongue fur（36.7%）,less tongue fur（12.5%）and white slippery tongue fur（11.7%）in COPD-CCP was higher than COPD（30.8%,6.4%,and 2.7%）;fine slippery pulse（9.2%）,fine sinking pulse（18.3%）and weak sinking pulse（15.0%）in COPD-CCP was higher than that in COPD（2.0%,3.4%,and 5.4%）（P<0.05）;there was no significant difference in tongue color between the two groups（P>0.05）.In terms of TCM syndromes,170 cases of phlegm-heat in lung syndrome（57.6%）,76 cases of phlegm-blood stasis syndrome obstructing lung syndrome（25.8%）,24 cases of yang-deficiency-water-diffusion syndrome（8.1%）ranked top 3 in COPD;40 cases of yang-deficiency-water-diffusion syndrome（33.3%）,36 cases of phlegm-heat in lung syndrome（30.0%）,26 cases of phlegm-blood stasis syndrome obstructing lung syndrome（21.7%）ranked top 3 in COPD-CCP（P<0.001）.Conclusion:1.This study constructed and valid the predictive model of COPD complicated with CCP with high accuracy.2.Compared with COPD patients,with palpitation,peripheral edema,white greasy tongue fur,less tongue fur,white slippery tongue fur,fine slippery pulse,fine sinking pulse,and weak sinking pulse were related to CCP.In terms of TCM syndrome types, yang-deficiency-water-diffusion syndrome patients had the highest proportion of CCP.