急性心肌梗死患者rhPro-UK溶栓后心功能恢复不良的基线预测风险模型的构建分析  

Construction and analysis of baseline predictive risk model for poor recovery of cardiac function after thrombolysis in patients with acute myocardial infarction

作　　者：韩孝宇[1] 代玉涵 朱爱红[1] 姜晓冬 安建立[2] 张扬[1] 王文广[1] 邸亚丽[3] 杨红梅[1] 撖越 HAN Xiaoyu;DAI Yuhan;ZHU Aihong;JIANG Xiaodong;AN Jianli;ZHANG Yang;WANG Wenguang;DI Yali;YANG Hongmei;HAN Yue(Department of Cardiology,First Hospital of Qinhuangdao,Qinhuangdao Hebei 066000,China)

机构地区：[1]秦皇岛市第一医院心内科,河北秦皇岛066000 [2]秦皇岛市第一医院介入治疗科,河北秦皇岛066000 [3]唐山市工人医院心内科,河北唐山063000

出　　处：《中国急救复苏与灾害医学杂志》2022年第10期1268-1272,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省卫健委2020年度医学科学研究项目(编号:20201512);河北省秦皇岛市科技计划自筹支撑项目(编号:201902A168)。

摘　　要：目的 构建急性心肌梗死患者rhPro-UK溶栓后心功能恢复不良的预测模型并评估该模型预测急性心肌梗死患者rhPro-UK溶栓后心功能恢复不良的预测价值。方法 纳入2019年6月—2020年6月于唐山市工人医院心就诊的133例急性心肌梗死rhPro-UK溶栓患者为研究对象,根据随访期间患者心功能恢复情况分为恢复不良组和对照组;采用多因素Logistics回归分析影响急性心肌梗死患者rhPro-UK溶栓后心功能恢复不良的危险因素,构建预测模型并检验模型效能。结果 随访期间3例因失访被排除,共纳入有效样本130例,其中46例患者出现心功能恢复不良,发生率为35.38%,据此分为恢复不良组(46例)和对照组(84例);两组间肌酸激酶同工酶(CK-MB)、氨基末端B型利钠肽前体(NT-proBNP)、心肌肌钙蛋白(hs-cTnT)、左室搏出量(LVSV)、killip心肌梗死等级、QRS失真畸变、片段性QRS波、LDL比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,CK-MB[OR=1.518,95%CI(0.992,2.260)]、Hs-cTnT[OR=1.715,95%CI(1.004,2.025)]、killip心肌梗死等级[OR=2.511,95%CI(0.826,10.230)]、QRS失真畸变[OR=3.927,95%CI(2.821,10.230)]、片段性QRS波[OR=1.832,95%CI(0.342,2.286)]、LDL[OR=2.412,95%CI(0.636,3.655)]均是影响急性心肌梗死患者rhPro-UK溶栓后心功能恢复不良的危险因素(P<0.05);ROC曲线分析显示,预测模型的曲线下面积为0.951(95%CI=0.899~0.981),敏感度为97.50%,特异度为82.22%,一致性良好。结论 CK-MB、Hs-cTnT、心肌梗死等级、QRS失真畸变、片段性QRS波、LDL均为影响急性心肌梗死rhPro-UK溶栓患者心功能恢复不良的危险因素,通过建立预测模型能够做到早期预警,有效帮助临床医师制定治疗方案。Objective To explore the risk factors of poor cardiac function recovery after rhPro-UK thrombolysis in patients with acute myocardial infarction,construct a predictive model and evaluate the predictive value of this model in predicting poor cardiac function recovery after rhPro-UK thrombolysis in patients with acute myocardial infarction.Methods A total of 133 patients with acute myocardial infarction rhPro-UK thrombolysis in our hospital from June 2019 to June 2020 were enrolled as the research objects.The patients were divided into poor recovery group and control group according to their cardiac function recovery.Multivariate Logistics was used to analyze isk factors affecting poor recovery of cardiac function in patients with acute myocardial infarction rhPro-UK after thrombolysis,predictive models and testing of model efficacy were constructed.Results During the follow-up period,3 cases were excluded due to loss of follow-up.A total of 130 valid samples were included.Among them,46 patients had poor recovery of cardiac function,the incidence rate was 35.38%.Based on this,they were divided into poor recovery group(46 cases)and control group(84 cases).The clinical data of the two groups of patients showed that CK-MB,NT proBNP,cardiac troponin(hs-cTnT),left ventricular stroke volume(LVSV),killip myocardial infarction grade,QRS distortion,fragmentation Comparison of QRS complex and low-density lipoprotein,the difference was statistically significant(P<0.05);multivariate logistic regression analysis showed that CK-MB[OR=1.518,95%CI(0.992,2.260)],Hs-cTnT[OR=1.715,95%CI(1.004,2.025)],killip myocardial infarction grade[OR=2.511,95%CI(0.826,10.230)],QRS distortion[OR=3.927,95%CI(2.821,10.230)],Fragmental QRS complex[OR=1.832,95%CI(0.342,2.286)],low-density lipoprotein[OR=2.412,95%CI(0.636,3.655)]all affect rhPro-UK after thrombolysis in patients with acute myocardial infarction Risk factors for poor recovery of cardiac function(P<0.05);ROC curve analysis showed that the area under the curve of the prediction model was

关 键 词：急性心肌梗死 rhPro-UK溶栓 心功能 经皮冠状动脉 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病]