主动脉夹层和非ST段抬高急性冠脉综合征鉴别模型构建研究  

Study on a model for differentiating aortic dissection and non ST segment elevation acute coronary syndrome

作　　者：陈晓晴[1] 吴轲[1] 徐成润[2] CHEN Xiao-Qing;Wu Ke;XU Cheng-Run(Department of Cardiology,Cardiovascular,No.909 Hospital,Joint Logistics Support Force of PLA,Dongnan Hospital of Xiamen University,School of Medicine,Xiamen University,Zhangzhou 363000,China;Department of Infection,Cardiovascular,No.909 Hospital,Joint Logistics Support Force of PLA,Dongnan Hospital of Xiamen University,School of Medicine,Xiamen University,Zhangzhou 363000,China)

机构地区：[1]联勤保障部队第九○九医院厦门大学附属东南医院心血管内科,福建省漳州市363000 [2]联勤保障部队第九○九医院厦门大学附属东南医院感染科,福建省漳州市363000

出　　处：《中国心血管病研究》2022年第6期522-526,共5页Chinese Journal of Cardiovascular Research

基　　金：福建省医学创新课题项目(2018-CX-42)。

摘　　要：目的 构建鉴别主动脉夹层和非ST段抬高急性冠脉综合征(non-ST segment elevation ACS,NSTE-ACS)的诊断模型。方法 回顾性分析2017年1月至2020年12月我院收治的主动脉夹层和NSTEACS患者460例。使用二元logistic回归模型分析鉴别诊断主动脉夹层的因素,并构建预测诊断模型。使用ROC曲线评估所构建诊断模型的诊断效能。结果 最终纳入460例患者,其中164例主动脉夹层患者和296例NSTE-ACS患者。Logistic回归模型可见,患者严重疼痛、发生撕裂痛、D-二聚体水平升高和肌钙蛋白(troponin I,TnI)水平低、脉搏不对称是主动脉夹层发生的影响因素,根据上述因素对应危险系数构建主动脉夹层预测模型如下:Y=1.993×疼痛严重程度+3.019×撕裂痛+2.795×D-二聚体-3.507×TnI水平+0.788×脉搏不对称-4.92。使用所构建预测模型对全部患者计算赋值后,构建ROC曲线下,可见其曲线下面积为0.983,敏感度为0.976,特异度为0.875。结论 本研究所开发并验证的主动脉夹层和NSTE-ACS鉴别模型可作为快速准确区分的潜在工具,值得进一步研究。Objective To establish a diagnostic model for differentiating aortic dissection from non-ST segment elevation acute coronary syndrome(NSTE-ACS). Methods A total of 460 patients with aortic dissection and NSTE-ACS admitted to our hospital from January 2017 to December 2020 were retrospectively analyzed.Binary logistic regression model was used to analyze the factors of differential diagnosis of aortic dissection, and the predictive diagnostic model was constructed. ROC curve was used to evaluate the diagnostic efficiency of the model. Results Among the patients, there were 164 patients with aortic dissection and 296 patients with NSTEACS. Logistic regression model showed that severe pain, tearing pain, elevated D-dimer level, low troponin I(TnI)level and asymmetric pulse were the influencing factors of aortic dissection According to the corresponding risk coefficient of the above factors, the prediction model of aortic dissection was constructed as follows: Y=1.993 ×pain severity+3.019×tearing pain+2.795×D-dimer-3.507×TnI level+0.788×pulse asymmetry-4.92. The area under the ROC curve was 0.983 with the sensitivity 0.976 and the specificity 0.875. Conclusion The model developed and validated here could be used as a potential tool for the rapid and accurate differentiation for aortic dissection and NSTE-ACS, which is worthy of further study.

关 键 词：主动脉夹层 非ST段抬高急性冠脉综合征 胸痛 鉴别诊断 

分 类 号：R541.4[医药卫生—心血管疾病] R543.1[医药卫生—内科学]