老年风湿性心脏病患者瓣膜手术前冠心病风险预测模型的建立及评价  

A prediction model for coronary artery diseases in elder patients undergoing operations for rheumatic heart valve disease: establishment and assessment

作　　者：李树春[1] 廖学文[1] 李莉[1] 张罗漫[2] 徐志云[1] 

机构地区：[1]第二军医大学长海医院胸心外科,上海200433 [2]第二军医大学临床流行病学与循证医学中心,上海200433

出　　处：《第二军医大学学报》2011年第7期706-709,共4页Academic Journal of Second Military Medical University

基　　金：卫生部卫生行业科研专项基金(200802096)~~

摘　　要：目的筛选危险因素,建立老年风湿性心脏病（RHVD）患者瓣膜手术前冠心病危险度预测模型,以指导冠脉造影检查的选择。方法基于1998~2009年我院连续585例患者的资料,通过Logistic回归筛选老年RHVD患者瓣膜手术前冠心病的危险因素,建立危险度预测模型并以bootstrap方法优化,以预测概率P〈0.05为低危险度。以接受者操作特性曲线（ROC曲线）比较该模型和国外类似模型的诊断效能。结果老年RHVD患者并发冠心病的危险因素中影响突出的是：男性、年龄、心绞痛、高血压、高胆固醇血症。成功建立危险度预测模型。151例患者被定义为低危险度,其中4例合并冠心病,均为单支血管病变。ROC曲线下面积0.793,对国人老年RHVD患者术前冠心病危险度具有较优预测效能。结论成功构建了老年RHVD患者瓣膜手术前冠心病风险预测模型,有利于我国老年RHVD患者瓣膜手术前冠心病的筛查。Objective To screen the risk factors for coronary artery diseases（CAD） before undergoing operation for rheumatic heart valve disease（RHVD） in elder patients and to establish a logistic model for predicting CAD,so as to guide the selection of coronary angiography.Methods A total of 585 elder patients who underwent routine coronary angiography before heart valve operations for RHVD during 1998-2009 were analyzed in the present study.Logistic regression was employed to screen the risk factors for CAD and to establish a bootstrap logistic regression model,with P0.05 used for identifying the low-risk patients.The receiver operating characteristic（ROC） curves were used to compare the diagnosis efficacies of the established model and other similar models.Results It was found that the independent predictors of CAD in elder RHVD patients included age,male sex,angina,hypertension,and hypercholesterolemia.A predicting logistic model was successfully established.According to the model,155 patients were designated as low risk,with 4（2.6%） complicated with single-vessel disease CAD.The model showed better discrimination efficacy compared with the existing ones,with the area under the ROC curve being 0.793.Conclusion We have successfully established a predicting model for CAD in elder patients undergoing operation for RHVD,which may help to screen CAD in elder patients before receiving heart valve operations for RHVD.

关 键 词：风湿性心脏病 冠心病 心脏外科手术 危险因素 Logistic模型 

分 类 号：R654.27[医药卫生—外科学]