年龄校正Charlson合并症指数在鉴别急性心肌炎和急性心肌梗死中的价值  

Value of age-adjusted Charlson comorbidity index in differentiating myocarditis from acute myocardial infarction

作　　者：叶渊文 潘琴 李飞飞 陈玲珑[1] YE Yuanwen;PAN Qin;LI Feifei;CHEN Linglong(Department of Emergency,the Third Clinical Institute Affiliated to Wenzhou Medical University,Wenzhou People's Hospital,Wenzhou 325000,China;不详)

机构地区：[1]温州医科大学第三临床医学院(温州市人民医院)急诊医学科,325000 [2]温州医科大学第三临床医学院(温州市人民医院)麻醉手术室,325000

出　　处：《浙江医学》2022年第12期1295-1299,共5页Zhejiang Medical Journal

摘　　要：目的探讨年龄校正Charlson合并症指数(ACCI)在鉴别急性心肌炎和急性心肌梗死中的价值。方法收集2018—2019年美国重症监护医学信息数据库-IV(MIMIC-Ⅳ)中诊断为急性心肌炎和急性心肌梗死患者的基本信息和临床资料,提取人口统计学资料、生命体征、血常规、血生化、格拉斯哥昏迷指数(GCS)、Logistic器官功能障碍系统评分(Lods)、牛津急性疾病严重程度评分(Oasis)、简化急性生理评分(Saps-Ⅱ)及ACCI。根据出院诊断分为急性心肌炎组和急性心肌梗死组,单因素分析比较两组患者上述指标的差异,多因素回归分析筛选危险因素,并采用AUC评价ACCI鉴别诊断的效能。结果共计6811例患者纳入研究,其中急性心肌炎组206例,急性心肌梗死组6605例。单因素分析显示:两组患者年龄、WBC、RBC、Hb、红细胞分布宽度、PLT、ALT、肌酐、尿素氮、肌钙蛋白T、GCS、Lods、Oasis、Saps-Ⅱ及ACCI均有统计学差异(均P<0.05)。多因素分析显示:年龄、ALT、ACCI是独立危险因素。ACCI的AUC为0.803,截断值为3.5,灵敏度和特异度分别为0.909和0.607。结论ACCI在急性心肌炎和急性心肌梗死中有较好的区分度,适用于急性心肌炎和急性心肌梗死的早期鉴别。Objective To explore the value of age-adjusted Charlson comorbidity index(ACCI)in differentiating myocarditis from acute myocardial infarction.Methods Basic information and clinical data were extracted from Medical Information Mart for Intensive Care database-IV,including the demographics data,vital signs,blood routine,blood biochemistry,myocardial enzymes,Glasgow coma scale(GCS),Logistic organ dysfunction system score(Lods),Oxford acute severity of illness score(Oasis),simplified acute physiological score(Saps-II)and AACCI.According to the discharge diagnosis,the patients were divided into myocarditis group and acute myocardial infarction group.Risk factors of myocardial infarction were analyzed with multivariate regression,the area under receiver operating characteristic curve(ROC)was used to evaluate the efficiency of ACCI.Results A total of 6811 patients were enrolled in the study,including 206 patients with myocarditis and 6605 patients with acute myocardial infarction.Univariate analysis showed that there were significant differences in age,white blood cell,red blood cell,hemoglobin,distribution width of red blood cell,platelet,alanine transaminase,creatinine,urea nitrogen,cardiac enzymes,GCS,Lods,Oasis,Saps-II and ACCI between two groups.Multiple regression analysis showed that age,alanine transaminase and ACCI were independent risk factors.The AUC of ACCI was 0.803,taking the cut-off value of 3.5,sensitivity and specificity of ACCI for differentiating myocarditis and acute myocardial infarction was 0.909 and 0.607,respectively.Conclusion ACCI can effectively differentiate between myocarditis and acute myocardial infarction,suggesting that it may be used for early differential diagnosis.

关 键 词：急性心肌炎 急性心肌梗死 Charlson合并症指数 

分 类 号：R542.22[医药卫生—心血管疾病]