不同评分系统对急性心肌梗死合并心原性休克患者近期死亡预测价值的比较  

Comparison on the predictive value of different scoring systems for risk of short-term death in patients with acute myocardial infarction complicating cardiogenic shock

作　　者：郭超[1] 罗晓亮[1] 高晓津[1] 王娟[1] 刘蓉[1] 李佳[1] 张峻[1] 杨伟宪[1] 胡奉环[1] 吴元[1] 杨跃进[1] 乔树宾[1] Guo Chao;Luo Xiaoliang;Gao Xiaojin;Wang Juan;Liu Rong;Li Jia;Zhang Jun;Yang Weixian;Hu Fenghuan;Wu Yuan;Yang Yuejin;Qiao Shubin(Center of Coronary Heart Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院冠心病诊治中心,100037

出　　处：《中华心血管病杂志》2018年第7期529-535,共7页Chinese Journal of Cardiology

摘　　要：目的比较目前常用的7种评分系统及改良的CADILLAC-plus评分对急性心肌梗死合并心原性休克患者近期死亡的预测价值。方法纳入2014年6月至2018年1月在阜外医院住院的急性心肌梗死合并心原性休克患者126例，对其临床资料进行回顾性分析。根据明确诊断心原性休克后28 d患者是否存活，将患者分为存活组（49例）及死亡组（77例）。分别计算入住冠心病重症监护室（CCU）后24 h内的APACHE Ⅱ、APACHE Ⅲ、SAPSⅡ、PAMI、TIMI-STEMI、TIMI-NSTEMI和CADILLAC评分，并通过对CADILLAC评分进行改良获得CADILLAC-plus评分，比较不同评分系统对急性心肌梗死合并心原性休克患者发病后28 d死亡的预测价值。结果死亡组的APACHE Ⅱ、APACHE Ⅲ、SAPS Ⅱ、PAMI、TIMI-STEMI、TIMI-NSTEMI、CADILLAC和CADILLAC-plus评分均高于存活组[分别为（28.9±10.2）分比（21.8±8.3）分、94.0（57.0,114.0）分比57.0（45.4,81.5）分、62.0（46.0,81.0）分比47.0（41.5,60.5）分、7.0（6.0,9.0）分比6.0（6.0,7.5）分、10.0（9.0,11.0）分比9.0（8.0,10.0）分、4.0（3.0,5.0）分比3.0（3.0,4.0）分、10.0（7.0,12.0）分比7.0（5.0,9.0）分和10.0（8.0,14.0）分比7.0（5.0,10.0）分，P均〈0.01]。APACHE Ⅱ、APACHE Ⅲ、SAPS Ⅱ、PAMI、TIMI-STEMI、TIMI-NSTEMI和CADILLAC评分预测死亡的ROC曲线下面积分别为0.820、0.797、0.785、0.667、0.657、0.711和0.821，截断点分别为27.5、79.5、66.0、8.5、10.5、3.5和8.5分，敏感度分别为0.766、0.844、0.649、0.494、0.494、0.740和0.753，特异度分别为0.816、0.755、0.837、0.204、0.796、0.571和0.755；CADILLAC-plus评分的ROC曲线下面积为0.885，截断点为9.5分，敏感度为0.896，特异度为0.735，优于其他评分系统。结论目前常用的7种评分系统均可较好地预测急性心肌梗死合并心原性休克患者的近期死亡，而改良的CADILLAC-plus评分的预测能力更佳。ObjectiveTo compare predictive value of the current 7 scoring systems and CADILLAC-plus scoring system for risk of short-term deathin patients with acute myocardial infarction complicating cardiogenic shock.MethodsA total of 126 acute myocardial infarction patients complicating cardiogenic shock hospitalized in Fuwai hospital from June 2014 to January 2018 were enrolled in this study, the clinical data were retrospectively analyzed. The patients were divided into survival group（49 cases） and death group（77 cases） according to survival or not at 28 days after diagnosis of cardiogenic shock.The scores of APACHE Ⅱ,APACHE Ⅲ,SAPS Ⅱ,PAMI, TIMI-STEMI,TIMI-NSTEMI,and CADILLAC were calculated within 24 hours in coronary care unit （CCU）,and scores of CADILLAC-plus, which is an improved score derived from CADILLAC, was also calculated. The predictive value of the different scoring systems for 28 day smortality of acute myocardial infarction patients complicating cardiogenic shock were compared in this patient cohort.ResultsScores of APACHEⅡ,APACHEⅢ,SAPSⅡ,PAMI,TIMI-STEMI, TIMI-NSTEMI,CADILLAC,and CADILLAC-plus were all significantly higher in death group than in survival group： （28.9±10.2 vs. 21.8±8.3,94.0 （57.0,114.0） vs. 57.0 （45.4,81.5） ,62.0 （46.0,81.0） vs. 47.0 （41.5,60.5） ,7.0 （6.0,9.0） vs. 6.0 （6.0,7.5） ,10.0 （9.0,11.0） vs. 9.0 （8.0,10.0） ,4.0 （3.0,5.0） vs. 3.0 （3.0,4.0） ,10.0 （7.0,12.0） vs. 7.0 （5.0,9.0） ,and 10.0 （8.0,14.0） vs. 7.0 （5.0,10.0） , respectively, all P〈0.01）.The area under the curve（AUC） of receiver operating characteristic（ROC） curve for predicting 28 days death of APACHE Ⅱ,APACHE Ⅲ,SAPS Ⅱ,PAMI, TIMI-STEMI,TIMI-NSTEMI,and CADILLAC scoring systems were 0.820,0.797,0.785,0.667,0.657,0.711,and 0.821,respectively and cut-off value was 27.5,79.5,66.0,8.5,10.5,3.5,and 8.5, respectively and the sensitivity was 0.766,0.844,0.649,0.494,0.494,0.740,and 0.753, respectively and specificity was 0.816,0.755,0.837,0

关 键 词：心肌梗死 休克 心原性 预后 

分 类 号：R541.64[医药卫生—心血管疾病] R542.22[医药卫生—内科学]