2026 年第 4 期 第 21 卷

慢性心力衰竭患者美托洛尔治疗期间发生支气管痉挛的影响因素分析

Analysis of influencing factors for bronchospasm in patients with chronic heart failure during metoprolol treatment

作者：王旭薇成康姚靖雯

英文作者：Wang Xuwei Cheng Kang Yao Jingwen

单位：江苏大学附属医院药剂科，镇江212001

英文单位：Department of Pharmacy the Affiliated Hospital of Jiangsu University Zhenjiang 212001 China

关键词：慢性心力衰竭；美托洛尔；支气管痉挛；列线图；影响因素

英文关键词：Chronicheartfailure;Metoprolol;Bronchospasm;Nomogram;Influencingfactors

• 摘要：

• 目的 分析慢性心力衰竭(CHF)患者美托洛尔治疗期间发生支气管痉挛的影响因素。方法 选取2022年1月至2024年12月江苏大学附属医院收治的284例接受美托洛尔治疗的CHF患者作为研究对象。根据治疗期间是否发生支气管痉挛，将患者分为支气管痉挛组和非支气管痉挛组，并收集患者的临床资料。采用单因素和多因素Logistic回归分析筛选支气管痉挛的独立影响因素，通过R软件构建可视化列线图，通过受试者工作特征(ROC)曲线、校准曲线和决策曲线对可视化列线图的区分能力、校准度和临床有效性进行评价。结果 本研究共纳入284例接受美托洛尔治疗的CHF患者，治疗期间共有43例患者发生支气管痉挛，发生率为15.1%(43/284)。支气管痉挛组与非支气管痉挛组患者的年龄、吸烟、哮喘病史、慢性阻塞性肺疾病(COPD)合并情况、第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)及B型脑钠肽(BNP)水平等资料比较，差异均有统计学意义(均P＜0.05)。多因素Logistic回归分析结果显示，年龄(比值比=1.114，95%置信区间：1.054～1.178，P＜0.001)、吸烟(比值比=2.839，95%置信区间：1.266～6.362，P=0.011)、哮喘病史(比值比=3.631，95%置信区间：1.228～10.737，P=0.020)、合并COPD(比值比=5.008，95%置信区间：2.095～11.968，P＜0.001)、BNP(比值比=1.011，95%置信区间：1.005～1.017，P＜0.001)是CHF患者美托洛尔治疗期间发生支气管痉挛的独立危险因素，而FEV1/FVC(比值比=0.926，95%置信区间：0.889～0.965，P＜0.001)是其独立保护因素。构建的可视化列线图曲线下面积为0.860(95%置信区间：0.797～0.923)，校准曲线与理想对角线重合性高(Hosmer-Lemeshow检验χ2=7.243，P=0.511)，决策曲线在阈值概率0～98%范围内净获益值较高。结论 年龄、吸烟、哮喘病史、合并COPD、FEV1/FVC和BNP是CHF患者美托洛尔治疗期间发生支气管痉挛的独立影响因素。本研究构建的可视化列线图具有良好的临床实用性，可为早期识别高危患者、优化用药管理提供参考。

• Objective To analyze the influencing factors for bronchospasm in patients with chronic heart failure (CHF) during metoprolol treatment. Methods A total of 284 CHF patients treated with metoprolol who were admitted to the Affiliated Hospital of Jiangsu University from January 2022 to December 2024 were enrolled as research subjects. According to the occurrence of bronchospasm during treatment, the patients were divided into the bronchospasm group and the non-bronchospasm group, and the clinical data of the patients were collected. Univariate and multivariate Logistic regression analyses were used to screen the independent influencing factors of bronchospasm. A visual nomogram was constructed by R software, and the discrimination ability, calibration and clinical validity of the visual nomogram were evaluated by receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis. Results A total of 284 CHF patients treated with metoprolol were included in this study, and 43 patients developed bronchospasm during treatment, with an incidence rate of 15.1%(43/284). There were statistically significant differences in age, smoking status, history of asthma, complicated chronic obstructive pulmonary disease (COPD), forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) ratio and brain natriuretic peptide (BNP) level between the bronchospasm group and the non-bronchospasm group (all P＜0.05). Multivariate Logistic regression analysis showed that age (odds ratio=1.114, 95% confidence interval: 1.054-1.178, P＜0.001), smoking (odds ratio=2.839, 95% confidence interval: 1.266-6.362, P=0.011), history of asthma (odds ratio=3.631, 95% confidence interval: 1.228-10.737, P=0.020), complicated COPD (odds ratio=5.008, 95% confidence interval: 2.095-11.968, P＜0.001) and BNP level (odds ratio=1.011, 95% confidence interval: 1.005-1.017, P＜0.001) were independent risk factors for bronchospasm in CHF patients during metoprolol treatment, while FEV1/FVC ratio (odds ratio=0.926, 95% confidence interval: 0.889-0.965, P＜0.001) was an independent protective factor. The area under the curve of the constructed visual nomogram was 0.860(95% confidence interval: 0.797-0.923). The calibration curve had a high coincidence with the ideal diagonal line (Hosmer-Lemeshow test χ2=7.243, P=0.511), and the decision curve showed a high net benefit value in the threshold probability range of 0-98%. Conclusion Age, smoking, history of asthma, complicated COPD, FEV1/FVC ratio and BNP level are independent influencing factors for bronchospasm in CHF patients during metoprolol treatment. The visual nomogram constructed in this study has good clinical practicability, which can provide a reference for early identification of high-risk patients and optimization of medication management.