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作 者:林锐 王媛 周宁 严昱 周翔天[3] 杜杰[1,2] LIN Rui;WANG Yuan;ZHOU Ning;YAN Yu;ZHOU Xiangtian;DU Jie(Department of Cardiology,The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang,325035,China;Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Disease;State Key Laboratory of Ophthalmic Optics and Visual Science,Optometry,Eye Hospital,Wenzhou Medical University)
机构地区:[1]温州医科大学附属第二医院心内科,浙江温州325035 [2]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所血管生物研究室 [3]温州医科大学眼视光医院省部共建眼视光学和视觉科学国家重点实验室
出 处:《临床心血管病杂志》2021年第3期248-253,共6页Journal of Clinical Cardiology
基 金:国家自然科学基金(No:81861128025)。
摘 要:目的:使用机器学习确定与主动脉瓣置换手术后不良心血管事件相关的特征性生物标志物,并验证其预测不良心血管事件发生的价值。方法:纳入2016-2019年在北京安贞医院住院行主动脉瓣置换手术的患者共1455例,收集其临床特征和实验室检查指标。对所有患者进行1年以上的术后随访,以全因死亡、心力衰竭或心肌梗死发作再入院作为不良心血管事件,使用机器学习筛选特征性生物标志物,进一步验证其预测预后的价值。结果:使用多种机器学习构建模型确定特征性生物标志物为术前B型钠尿肽和术后24 h的超敏肌钙蛋白I。COX比例风险模型结果显示,术前B型钠尿肽[HR(95%CI):1.758(1.191,2.595),P<0.01]与术后超敏肌钙蛋白I[HR(95%CI):1.830(1.137,2.945),P=0.013]是主动脉瓣置换术后不良事件发生的独立危险因素。当术前B型钠尿肽和术后24 h的超敏肌钙蛋白I共同升高时,能在一定程度上预测主动脉瓣置换患者不良事件发生[HR(95%CI):1.937(1.072,3.500),P=0.028)]。结论:基于机器学习方法确定特征性生物标志物为术前B型钠尿肽和术后24 h的超敏肌钙蛋白I,二者联合可用于预测主动脉瓣置换术后的不良心血管事件。Objective:To use machine learning to identify the characteristic biomarkers related to major adverse cardiovascular events(MACE)after aortic valve replacement,and to verify their prognostic value.Methods:A total of 1455 patients who underwent aortic valve replacement in Beijing Anzhen Hospital from 2016 to 2019 were enrolled in the study.Their clinical characteristics and the value of serum biomarkers were collected.All patients were followed up for more than 1 year.Outcomes were defined as all-cause death,admission to hospital with heart failure or myocardial infarction.Machine learning was used to screen characteristic biomarkers and verify their prognostic value.Results:The machine learning identified the characteristic biomarkers as preoperative natriuretic peptide-B and high-sensitivity troponin I 24 hours after operation.COX regression model showed that preoperative natriuretic peptide-B(HR[95%CI]:1.758[1.191,2.595],P<0.01)and high-sensitivity troponin I(HR[95%CI]:1.830[1.137,2.945],P=0.013)were independent risk factors for MACE after aortic valve replacement.The increase of the both natriuretic peptide-B and high-sensitivity troponin I could predict the occurrence of MACE(HR[95%CI]:1.937[1.072,3.500],P=0.028).Conclusion:The machine learning identifies the characteristic biomarkers are preoperative natriuretic peptide-B and post-operative high-sensitivity troponin I.Combination of the two biomarkers could predict MACE after aortic valve replacement.
关 键 词:主动脉瓣置换术 机器学习 血清生物标志物 不良事件
分 类 号:R542.5[医药卫生—心血管疾病]
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