加重老年急性心肌梗死患者冠状动脉病变风险的列线图预测模型建立  

Establishment of a nomogram prediction model for coronary artery disease risk in elderly patients with acute myocardial infarction

作　　者：杨艳梅[1] 杨栋梁[1] 赵文涛[1] 何雪娟[1] 王欣[1] 王佳旺[2] 刘凡[3] 孟庆兰 Yang Yanmei;Yang Dongliang;Zhao Wentao;He Xuejuan;Wang Xin;Wang Jiawang;Liu Fan;Meng Qinglan(Cangzhou Medical College,Cangzhou 061001,Hebei,China;First Department of Cardiology,Cangzhou Central Hospital,Cangzhou 061001,Hebei,China;Second Department of Cardiology,Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei,China;First Department of Cardiology,Cangzhou People's Hospital,Cangzhou 061001,Hebei,China)

机构地区：[1]沧州医学高等专科学校,河北沧州061001 [2]沧州市中心医院心内一科,河北沧州061001 [3]河北医科大学第二医院心内二科,河北石家庄050000 [4]沧州市人民医院心内一科,河北沧州061001

出　　处：《中华危重病急救医学》2021年第8期967-972,共6页Chinese Critical Care Medicine

基　　金：河北省卫生健康委员会指导项目(20200282);河北省沧州市科技研发指导计划项目(131302063)。

摘　　要：目的构建加重老年急性心肌梗死(AMI)患者冠状动脉(冠脉)病变风险列线图预测模型。方法回顾性分析2015年7月至2020年3月在沧州市中心医院心内科行冠脉造影的老年AMI住院患者的临床资料,包括年龄、性别、吸烟史、疾病史、家族史、血压、左室射血分数(LVEF)及入院时的多项生化指标,如总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白〔Lp(a)〕、载脂蛋白(ApoA、ApoB)、ApoA/B比值、总胆红素(TBil)、直接胆红素(DBil)、间接胆红素(IBil)、空腹血糖(FBG)及尿酸(UA)。按照8∶2的比例将患者分为模型建立组(n=2484)及外部验证组(n=683);比较两组中Gensini评分0~20分(轻度病变组)与Gensini评分≥81分(重度病变组)患者间各指标的差异,采用Lasso回归和Logistic回归分析加重老年AMI患者冠脉病变风险的危险因素,然后建立列线图预测模型并进行评价和外部验证。结果①在模型建立组中,轻度病变患者(411例)与重度病变患者(417例)冠心病家族史、FBG和HDL-C比较差异有统计学意义〔冠心病家族史:3.6%比7.7%,FBG(mmol/L):5.88±1.74比6.43±2.06,HDL-C(mmol/L):1.48±0.69比1.28±0.28,均P<0.05〕;在外部验证组中,轻度病变患者(153例)与重度病变患者(132例)FBG、HDL-C比较差异也有统计学意义〔FBG(mmol/L):5.58±0.88比6.85±0.79,HDL-C(mmol/L):1.59±0.32比1.16±0.21,均P<0.05〕。②Lasso回归分析筛选出冠心病家族史、FBG和HDL-C为影响老年AMI患者冠脉病变程度的危险因素,其系数分别为0.118、0.767、-0.558;Logistic回归分析显示,加重老年AMI患者冠脉病变风险的独立危险因素为FBG〔优势比(OR)=1.479,95%可信区间(95%CI)为1.051~2.082,P=0.025〕和HDL-C(OR=0.386,95%CI为0.270~0.553,P<0.001)。③对FBG和HDL-C这两个独立危险因素设置等级评分,建立每例患者对应的加重冠脉病变程度列线图预测风险模型,得出具有高于正常水平的Objective To establish a nomogram model for predicting the risk of coronary artery disease in elderly patients with acute myocardial infarction(AMI).Methods The clinical data of elderly patients with AMI who underwent coronary angiography in the department of cardiology of Cangzhou Central Hospital from July 2015 to March 2020 were analyzed,including age,gender,smoking history,underlying diseases,family history,blood pressure,left ventricular ejection fraction(LVEF),and several biochemical indicators at admission,such as total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),lipoprotein[Lp(a)],apolipoproteins(ApoA,ApoB),ApoA/B ratio,total bilirubin(TBil),direct bilirubin(DBil),indirect bilirubin(IBil),fasting blood glucose(FBG)and uric acid(UA).Patients were divided into model group(2484 cases)and validation group(683 cases)according to the ratio of 8∶2.According to Gensini score,the model group and validation group were divided into mild lesion group(0-20 points)and severe lesion group(≥81 points).The differences of each index between different coronary lesion degree groups were compared.Lasso regression and Logistic regression were used to analyze the risk factors of aggravating coronary lesion risk in elderly patients with AMI,and then the nomogram prediction model was established for evaluation and external validation.Results①In the model group,there were significant differences in the family history of coronary heart disease,FBG and HDL-C between the mild lesion group(411 cases)and the severe lesion group(417 cases)[family history of coronary heart disease:3.6%vs.7.7%,FBG(mmol/L):5.88±1.74 vs.6.43±2.06,HDL-C(mmol/L):1.48±0.69 vs.1.28±0.28,all P<0.05].In the validation group,there were significant differences between the mild lesion group(153 cases)and the severe lesion group[132 cases;FBG(mmol/L):5.58±0.88 vs.6.85±0.79,HDL-C(mmol/L):1.59±0.32 vs.1.16±0.21,both P<0.05].②Lasso regression analysis showed that family history o

关 键 词：老年 心肌梗死 冠状动脉病变 危险因素 列线图 

分 类 号：R542.22[医药卫生—心血管疾病]