房颤抗凝治疗后继发血栓风险的列线图模型构建  

Study on the construction of histogram model of the risk of secondary thrombosis in patients with atrial fibrillation after anticoagulant therapy

作　　者：张帆[1] ZHANG Fan(Department of Cardiovascular,The Third Hospital of Huzhou City,Huzhou 313000,China)

机构地区：[1]湖州市第三人民医院心血管内科,浙江湖州313000

出　　处：《全科医学临床与教育》2022年第3期230-234,共5页Clinical Education of General Practice

摘　　要：目的探讨房颤患者抗凝治疗后继发血栓风险的列线图模型构建及预防措施。方法回顾性分析240例房颤患者的临床资料,使用单因素和logistic多因素回归分析筛选出影响房颤抗凝治疗后继发血栓的独立危险因素,建立相关列线图预测模型,并提出预防性的措施。结果高龄、有瓣膜病、左心房(LA)内径>40 mm、血浆凝血酶-抗凝血酶Ⅲ复合物(TAT)≥15 ng/ml是房颤患者抗凝治疗后继发血栓的危险因素(OR分别=5.77、4.11、3.50、3.49,P均<0.05)。基于建立列线图预测模型,并对该模型进行内外部验证,结果显示建模集和验证集的C-index指数分别为0.84(95%CI 0.71~0.96)和0.84(95%CI 0.70~0.97),建模集和验证集的校正曲线均与标准曲线拟合较好,建模集和验证集的ROC曲线下面积分别为0.84和0.84。结论对房颤患者进行抗凝治疗时应充分考虑年龄、瓣膜病、LA内径、TAT等因素,本次研究基于危险因素建立的列线图模型可有效预测和量化继发血栓的风险,有助于医务人员根据患者具体情况采取合理的干预措施,改善患者预后。Objective To investigate the construction of a histogram model of the risk of secondary thrombosis in patients with atrial fibrillation(AF)after anticoagulant therapy and the preventive measures.Methods The clinical data of 240 cases of AF were retrospectively analyzed,and the risk factors for secondary thrombus after anticoagulation therapy in AF patients were analyzed,and related nomogram prediction model was established,thus to put forward preventive measures.Results Old age,valvular disease,LA diameter>40 mm,TAT≥15 ng/ml were risk factors for secondary thrombus after anticoagulation therapy in AF patients(OR=5.77,4.11,3.50,3.49,P<0.05).Nomogram prediction model is established,and the results of internal and external validation of the model showed that the modeling and validation sets of Cindex were 0.84(95%CI 0.71-0.96)and 0.84(95%CI 0.70-0.97).The areas under the ROC curve(AUC)of modeling and validation stets were 0.84 and 0.84.Conclusion Anticoagulant therapy in patients with atrial fibrillation should fully consider age,valvular disease,LA diameter,and TAT.This study model can effectively predict and quantify the risk of blood clots in the secondary,help medical workers take reasonable intervention measures on the basis of the condition of the patients,improve the prognosis of patients.

关 键 词：房颤 抗凝治疗 继发血栓 危险因素 列线图 

分 类 号：R541.75[医药卫生—心血管疾病]