摘要
目的分析ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后发生Q波形成的影响因素,并构建其列线图模型。方法选取2017年3月至2021年3月河池市第一人民医院收治的533例行PCI的STEMI患者作为研究对象,根据PCI后有无Q波形成将其分为Q波形成组(n=164)和无Q波形成组(n=369)。收集患者的基线资料及PCI前心功能指标〔左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)〕、心肌损伤标志物〔天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶、肌酸激酶同工酶、心肌肌钙蛋白I(cTnI)〕、血红蛋白。STEMI患者PCI后发生Q波形成的影响因素分析采用多因素Logistic回归分析。采用R软件的“rms”程序包构建STEMI患者PCI后Q波形成发生风险的列线图模型;采用Bootstrap法重复抽样1000次进行验证,计算一致性指数(CI),绘制校正曲线以分析该列线图模型的预测结果与实际结果的一致性;采用“rmda”软件包绘制决策曲线,分析该列线图模型预测STEMI患者PCI后发生Q波形成的净获益率。结果本组533例STEMI患者PCI后发生Q波形成164例,Q波形成发生率为30.77%。Q波形成组年龄大于无Q波形成组,男性占比和吸烟、合并糖尿病、TIMI血流分级为0~2级者占比及脑钠肽高于无Q波形成组,STB时间长于无Q波形成组,血红蛋白低于无Q波形成组(P<0.05)。多因素Logistic回归分析结果显示,年龄、吸烟、STB时间、脑钠肽、血红蛋白是STEMI患者PCI后发生Q波形成的独立影响因素(P<0.05)。基于上述影响因素构建STEMI患者PCI后Q波形成发生风险的列线图模型,结果显示,CI为0.976,该列线图模型预测STEMI患者PCI后发生Q波形成的校正曲线趋近于理想曲线;ROC曲线分析结果显示,该列线图模型预测STEMI患者PCI后发生Q波形成的AUC为0.976,最佳截断值为0.402,灵敏度为0.915,特异度为0.935。决策曲线分析结果显示,�
Objective To analyze the influencing factors of Q wave formation in patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI),and construct its risk prediction nomogram model.Methods A total of 533 STEMI patients undergoing PCI from March 2017 to March 2021 in Hechi First People's Hospital were selected as the research subjects.According to whether Q wave formed after PCI,they were divided into Q wave formation group(n=164)and non Q wave formation group(n=369).The baseline data,cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD)],myocardial injury markers[aspartate aminotransferase(AST),lactate dehydrogenase(LDH),creatine kinase,creatine kinase isoenzyme,cardiac troponin I(cTnI)]and hemoglobin of patients before PCI were collected.The influencing factors of Q wave formation in STEMI patients after PCI were analyzed by multivariate Logistic regression analysis,and the nomogram model of occurence risk of Q wave formation in STEMI patients after PCI was constructed by using the"rms"package of R software;the consistency index(CI)was calculated by repeated sampling 1000 times by Bootstrap method.The calibration curve was drawn to analyze the consistency between the predicted results of the nomogram model and the actual results;the decision curve was drawn by"rmda"software package to predict the net benefit rate of the nomogram model of occurence risk of Q wave formation in STEMI patients after PCI.Results There were 164 cases of Q wave formation after PCI in 533 patients with STEMI.The incidence of Q wave formation was 30.77%.The age of the Q wave formation group was larger than that of the non Q wave formation group,the proportion of patients with male,smoking,diabetes mellitus,grade 0-2 of TIMI blood flow were higher than those of the non Q wave formation,STB time was longer than that of the non Q wave formation,hemoglobin was lower than that of the non Q wave
作者
蓝璧高
林陆韬
LAN Bigao;LIN Lutao(Department of Cardiology,Hechi First People's Hospital,Hechi 546300,China)
出处
《实用心脑肺血管病杂志》
2022年第5期30-34,39,共6页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
心肌梗死
ST段抬高型心肌梗死
冠状动脉介入治疗
Q波
列线图模型
Myocardial infarction
ST-segment elevation myocardial infarction
Percutaneous coronary intervention
Q wave
Nomogram model
