ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后高校正心肌梗死溶栓治疗试验帧数临床预测模型  

Clinical predictive model for high corrected thrombolysis in myocardial infarction frame count for ST-segment elevation myocardial infarction patients after primary percutaneous coronary intervention

作　　者：陈桂坚 彭志坚[1] 黄华[1] CHEN Gui-jian;PENG Zhi-jian;HUANG Hua(Dearpartment of Cardiovascular Medicine,The Second People’s Hospital of Shantou City,Shantou 515000,China)

机构地区：[1]汕头市第二人民医院心血管内科一病区,广东汕头515000

出　　处：《中国介入心脏病学杂志》2020年第5期264-269,共6页Chinese Journal of Interventional Cardiology

基　　金：2019年汕头市第二批医疗卫生科技计划(自筹经费类)项目(汕府科[2019]70号)。

摘　　要：目的探讨ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术后校正心肌梗死溶栓治疗试验帧数(CTFC)的影响因素,并建立临床预测模型。方法入选2013年1月至2018年1月于汕头市第二人民医院心内科就诊的160例STEMI行急诊PCI患者。收集患者基本临床资料、血管造影资料、心电图资料、超声心动图资料。以CTFC 23为界限,将患者分为高CTFC组(65例)和低CTFC组(95例)。通过logistic多元回归分析辨别高CTFC的风险因子,并建立临床预测模型。通过ROC曲线评估预测模型的诊断效能。结果中性粒细胞与淋巴细胞比值(NLR)(OR 2.111,95%CI 0.818~3.198,P=0.001)、心率校正的QT间期离散度(QTcd)(OR 2.821,95%CI 1.660~4.797,P<0.001)、ST段回落(OR 1.962,96%CI 1.023~3.962,P=0.002)是高CTFC的独立预测因子。基于β系数给予以上变量各赋值1分,构成高CTFC临床预测模型——NQST(y=1.37x1+1.62x2+1.22x3+0.297,x1、x2、x3分别代表NLR、QTcd和ST段回落)评分,而且该模型具有良好的诊断效能(AUC 0.791,95%CI 0.705~0.877,P<0.001)。结论NQST临床评分模型能很好地预测STEMI患者急诊PCI后的高CTFC风险,提高该人群临床预后判断,并制定个体化治疗方案。Objective To investigate the risk factors of high corrected TIMI frame count(CTFC)for ST-segment elevation myocardial infarction(STEMI)patients after primary percutaneous coronary intervention(PCI),and establish a clinical predictive model for high CTFC.Methods A total of 160 consecutive STEMI patients who underwent primary PCI from January 2013 to January 2018 in Department of Cardiovascular Medicine,the Second People’s Hospital of Shantou City were enrolled in this study.Data including clinical characteristics,angiography,electrocardiogram,echocardiograph were collected.Patients with CFTC more than 23 were categorized as high CTFC group(65 cases),while others as low CTFC group(95 cases).Univariate and multiple regression analysis were preformed to identify the predictive factors of higher CTFC and to establish the predictive model.ROC curve was used to evaluate the predictive performance.Results Neutrophil to lymphocyte ratio(NLR)(OR 2.111,95%CI 0.818–3.198,P=0.001),corrected QT dispersion(QTcd)(OR 2.821,95%CI 1.660–4.797,P<0.001)and ST segment resolution(OR 1.962,95%CI 1.023–3.962,P=0.002)were independent predictive factors of higher CTFC.Base onβcoeffi cient of the above factors,one point was assigned to each of them to establish highly clinical predictive model—NQST(y=1.37x1+1.62x2+1.22x3+0.297,x1,x2,x3 stand for NLR,Qtcd and ST segment,respectively)score,which was found to gain good predictive performance(AUC 0.791,95%CI 0.705–0.877,P<0.001).Conclusions NQST score could serve as a good predictive system to evaluate high CTFC risk for STEMI patients underwent primary PCI.It supposed to help provide information for prognosis prediction,so as to work out individualized treatment strategy.

关 键 词：ST段抬高型心肌梗死 校正心肌梗死溶栓治疗试验帧数 临床预测模型 

分 类 号：R542.2[医药卫生—心血管疾病]