基于Lorenz散点图及三维RR散点图心率变异性构建列线图模型预测2型糖尿病心脏自主神经病变

doi:10.3969/j.issn.1006-6233.2025.06.29

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摘要 目的: 探讨基于Lorenz散点图及三维RR散点图的心率变异性(HRV)构建列线图模型对2型糖尿病(T2DM)心脏自主神经病变(DCAN)的预测价值。方法: 选取2021年4月至2024年3月期间收治的103例T2DM患者进行回顾性分析,所有患者进行Lorenz散点图及三维RR散点图分析,根据心血管反射试验(CART)将患者分为DCAN组和NDCAN组,比较两组HRV指标差异,分析散点图HRV指标与时域指标的相关性;通过R软件构建散点图HRV指标列线图模型,评估该模型对T2DM患者发生DCAN的预测价值。结果: DCAN组24h正常窦性心搏间期标准差(SDNN)、Lorenz散点图长轴(L0)、短轴(W)、长短轴比(L0/W)、三维RR散点图立体空间长轴(L)、xoy面二维图形长轴(L1)、二次投影x轴上长轴(L2)均低于NDCAN组,差异有统计学意义(P<0.05);Pearson相关性分析显示,L0、W、L、L1、L2与SDNN呈正相关(r=0.933、0.227、0.272、0.931、0.932,P<0.001),L0/W与SDNN相关性无统计学意义(r=0.054,P=0.586);多因素分析显示,L0、L1、L2是T2DM患者发生DCAN的独立影响因素(P<0.05);联合应用时建立3因子预测模型Ln(P/1-P)=11.127-0.005*L0-0.003*L1-0.010*L2,对模型进行Hosmer-Lemeshow拟合优度检验,P=0.842>0.05,计算ROC曲线下面积为0.942,其95%CI为0.899~0.985,决策曲线显示患者净获益均比另外两条极端曲线高,且阈值概率在0.02~0.92时,模型能产生更好的临床效益。结论: 基于Lorenz散点图及三维RR散点图HRV指标(L0、L0/W、L1)构建的列线图模型对T2DM患者发生DCAN的预测价值较高,该模型有助于早期识别DCAN高危患者。

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	李春燕
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关键词 ： 2型糖尿病, Lorenz散点图, 三维RR散点图, 心率变异性, 列线图模型, 心脏自主神经病变

Abstract：Objective: To investigate the predictive value of heart rate variability (HRV)-constructed column-linear graphical models based on Lorenz scatterplot and three-dimensional RR scatterplot for cardiac autonomic neuropathy (DCAN) in type 2 diabetes mellitus (T2DM). Methods: Totally 103 patients with T2DM admitted between April 2021 and March 2024 were selected for retrospective analysis, all patients underwent Lorenz scatterplot and 3D RR scatterplot analyses, patients were divided into DCAN and NDCAN groups based on cardiovascular reflexology test (CART), and the differences in HRV indices between the two groups were compared, and the correlation between scatterplot HRV indices and time domain indices was analysedWe constructed a column-line graph model of scatterplot HRV indexes by R software, and evaluated the predictive value of the model for the occurrence of DCAN in T2DM patients. Results: The standard deviation of 24-h normal sinus intervals (SDNN), long axis (L0), short axis (W), long-short axis ratio (L0/W) of Lorenz scatter plot, long axis of three-dimensional RR scatter plot in stereospace (L), long axis of two-dimensional graph in the xoy plane (L1), and long axis on the x-axis of the quadratic projection (L2) of DCAN group were lower than that of NDCAN group, and the difference was statistically significant (P<0.05); Pearson correlation analysis showed that L0, W, L, L1, L2 were positively correlated with SDNN (r=0.933, 0.227, 0.272, 0.931, 0.932, P<0.001), and the correlation between L0/W and SDNN was not statistically significant (r=0.054, P=0.586); and multifactorial analysis showed that L0, L1,L2 were independent influences on the occurrence of DCAN in T2DM patients (P<0.05); a 3-factor predictive model Ln(P/1-P)=11.127-0.005*L0-0.003*L1-0.010*L2 was established for the combined application, and the Hosmer-Lemeshow goodness-of-fit test was performed on the model, with P=0.842>0.05, theThe area under the ROC curve was calculated to be 0.942 with a 95% CI of 0.899 to 0.985, and the decision curves showed that the net patient benefit was higher in both cases than in the other two extreme curves, and that the model yielded a better clinical benefit with a threshold probability of 0.02 to 0.92. Conclusion: The column-linear graphical model constructed on the basis of Lorenz scatterplot and three-dimensional RR scatterplot HRV indicators (L0, L0/W, L1) has a high predictive value for the occurrence of DCAN in patients with T2DM, and the model can help to identify patients at high risk of DCAN at an early stage.

Key words： Type 2 diabetes mellitus Lorenz scatter plot Three-dimensional RR scatter plot Heart rate variability Nomogram model Cardiac autonomic neuropathy

基金资助:2019年安徽省重点研究与开发计划项目,(编号:201904b11020011);2023年度院级科研项目,(编号:2023ylc017)

通讯作者: 张松文

引用本文:

李春燕, 钟晔, 柴娟娟, 张松文. 基于Lorenz散点图及三维RR散点图心率变异性构建列线图模型预测2型糖尿病心脏自主神经病变[J]. 河北医学, 2025, 31(6): 1033-1038.
LI Chunyan, ZHONG Ye, CHAI Juanjuan, et al. Prediction of Cardiac Autonomic Neuropathy in T2DM by Constructing a Column-Linear Graphical Model Based on Lorenz Scatterplot and Three-Dimensional RR Scatterplot Heart Rate Variability. HeBei Med, 2025, 31(6): 1033-1038.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.06.29 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I6/1033

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