摘要
目的分析急性心肌梗死患者并发心力衰竭的危险因素并构建列线图模型。方法收集2020年1月至2020年12月于广东医科大学附属第二医院就诊的160例急性心肌梗死患者为研究对象,分为心力衰竭组(50例)和无心力衰竭组(110例)。记录临床资料,采用Logistic多元回归模型分析急性心肌梗死患者并发心力衰竭的独立危险因素。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)及校正、决策曲线评估Nomogram模型临床效能。结果与无心力衰竭组患者相比,心力衰竭组年龄≥65的患者比例、Killip心功能分级≥Ⅱ级患者比例、心率、呼吸频率及血尿素氮(blood urea nitrogen,BUN)、低密度脂蛋白胆固醇(low-density lipoprotein-cholesterol,LDL-C)、三酰甘油(triacylglycerol,TG)浓度较大、高密度脂蛋白胆固醇(high-density lipoprotein-cholesterol,HDL-C)浓度较小。BUN、TG、LDL-C、HDL-C、心率、呼吸频率的曲线下面积(area under the curve,AUC)为0.734、0.775、0.749、0.757、0.754、0.735;最佳截断值为9.38 mmol/L、2.07 mmol/L、2.46 mmol/L、1.28 mmol/L、102.48次/min、21.26次/min。年龄(≥65岁)、Killip心功能分级≥Ⅱ级、BUN(≥9.38 mmol/L)、TG(≤2.07 mmol/L)、LDL-C(>2.46 mmol/L)、HDL-C(≤1.28 mmol/L)是急性心肌梗死并发心力衰竭的独立危险因素。Nomogram模型预测急性心肌梗死并发心力衰竭的发生风险C-index为0.769(95%CI:0.694-0.796),Nomogram模型预测急性心肌梗死并发心力衰竭的风险阈值>0.17。结论基于年龄、Killip心功能分级≥Ⅱ级、BUN、TG、LDL-C、HDL-C构建预测急性心肌梗死并发心力衰竭的Nomogram模型具有临床应用价值。
Objectives To analyze the risk factors for patients with acute myocardial infarction(AMI)complicated by heart failure and construction of a nomogram model.Methods A total of 160 patients with AMI in The Second Affiliated Hospital of Guangdong Medical University from January 2020 to December 2020 were collected and divided into heart failure group(n=50)and heart failure free group(n=110).Clinical data were recorded,and the independent risk factors for AMI complicated by heart failure were analyzed by Logistic multiple regression model.Receiver operating characteristic curve(ROC),calibration and decision curve for assessing clinical efficacy of nomogram model.Results Compared with heart failure free group,heart failure group had a higher proportion of patients with age≥65,Killip functional class≥Ⅱand higher heart rate,respiratory rate,concentrations of blood urea nitrogen(BUN),low-density lipoprotein-cholesterol(LDL-C),triacylglycerol(TG)and lower concentration of HDL-C.The areas under the curve(AUCs)of BUN,TG,LDL-C,HDL-C,heart rate,and respiratory rate were 0.734,0.775,0.749,0.757,0.754,0.735;The optimalcut-offvalueswere 9.38mmol/L,2.07mmol/L,2.46mmol/L,1.28mmol/L,102.48beats/min,21.26beats/min.Age(≥65 years),Killip functional class≥Ⅱ,BUN(≥65 years),TG(≤2.07 mmol/L),LDL-C(>2.46 mmol/L),and HDL-C(≤1.28 mmol/L)were independent risk factors for patients with AMI complicated by heart failure.The nomogram model predicted the risk of AMI complicated by heart failure with a c-index of 0.769(95%CI:0.694-0.796),and the nomogram model predicted the risk threshold of AMI complicated by heart failure with risk treshold>0.17.Conclusions A nomogram was constructed to predict AMI complicated by heart failure based on age,Killip functional class≥Ⅱ,BUN,TG,LDL-C and HDL-C,which has the clinical value.
作者
唐燕平
李善敬
苏钟东
TANG Yan-ping;LI Shan-jing;SU Zhong-dong(The Second Affiliated Hospital of Guangdong Medical University,Zhanjiang,Guangdong 524000,China)
出处
《岭南心血管病杂志》
CAS
2022年第5期438-443,共6页
South China Journal of Cardiovascular Diseases
基金
湛江市科技计划项目(项目编号:2021B01254)。
关键词
心肌梗死
心力衰竭
影响因素
预测模型
myocardial infarction
heart failure
influencing factors
prediction model
