Stanford A型主动脉夹层术后不良事件风险预测模型的建立  

A postoperative adverse events prediction model for Stanford type A acute aortic dissection

作　　者：王秋吉 杨珏[2] 邝俊涛 冯玮琪 于长江 范瑞新 WANG Qiu-ji;YANG Jue;KUANG Jun-tao;FENG Wei-qi;YU Chang-jiang;FAN Rui-xin(The Second School of Clinical Medicine,Southern Medical University,Guangzhou 510515,China;Department of Cardiac Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of General Practice,Guagnzhou Tongde Community Health Serivice Center,Guangzhou 510407,China)

机构地区：[1]南方医科大学第二临床医学院,广州510080 [2]广东省心血管病研究所心外科广东省人民医院(广东省医学科学院),广州510080 [3]广州市白云区同德街社区卫生服务中心全科医疗部,广州510407

出　　处：《岭南心血管病杂志》2022年第6期491-496,共6页South China Journal of Cardiovascular Diseases

基　　金：国家重点研发计划:急性主动脉综合征高危预警及干预研究(项目编号:2017YFC1308003)。

摘　　要：目的分析急性Stanford A型主动脉夹层术后发生不良事件的独立危险因素,并建立风险预测模型。方法回顾性收集2017年9月至2020年3月连续就诊于广东省人民医院并行外科手术的342例急性Stanford A型主动脉夹层患者的围术期临床资料,根据患者术后30 d内是否发生不良事件将其分为发生组和未发生组,并按3∶1的比例随机分为建模组和验证组,通过Logistics回归分析进行统计并建立预测模型,在验证组中对预测模型进行效能评价并进行10倍交叉验证。结果术后发生不良事件104例,死亡24例,发生率分别为30.4%和7.0%。多因素Logistic回归分析的以下变量被纳入模型:年龄、术前天门冬氨酸氨基转移酶浓度≥120 U/L、室间隔厚度≥12 mm、同期行冠状动脉旁路移植术、体外循环时间≥250 min、延迟关胸,并据此建立预测模型。建模组受试者工作特征曲线(receiver operating characteristic curve,ROC)下面积=0.755(95%CI:0.686~0.823),通过Hosmer-Lemeshow检验发现,观测值和预测值的分离度差异无统计学意义(χ^(2)=7.594,df=8,P=0.474)。验证组ROC曲线下面积为0.714(95%CI:0.561~0.867),该组Hosmer-Lemeshow检验得出P=0.460(χ^(2)=7.735,df=8)。10倍交叉验证的平均ROC曲线下面积为0.716(0.507~0.841)。Hosmer-Lemeshow拟合优度检验P=0.474。结论本研究建立的Logistic模型能够成功预测Stanford A型主动脉夹层术后不良事件的发生风险且预测效能满意。Objectives To study the risk factors of postoperative adverse events after surgery for acute Stanford A aortic dissection and establish a prediction model.Methods Clinical data of consecutive 342 patients with acute Stanford A aortic dissection admitted to Guangdong Provincial People′s Hospital from September 2017 to March 2020were included in this retrospective assessment.They were included in postoperative adverse events group and nonadverse events group based on the presence or absence of adverse events within 30 days postoperatively.The patients were then randomly divided into training group and validation group in a ratio of 3∶1.Logistic regression analysis was used to statistically assess data and the prediction model was established.The prediction model′s effectiveness was evaluated via tenfold cross-validation of the validation group.Results After screening,342 patients were included in the study:104(30.4%)in the postoperative adverse events group and 238(69.6%)in the postoperative non-adverse events group.Based on Logistic regression analysis,the following variables were included in the model:age,concentration of preoperative aspartic transaminase≥120 U/L,interventricular septum thickness≥12 mm,coronary artery bypass grafting,cardiopulmonary bypass≥250 min and delayed sternal closure.The area under the receiver operating characteristic curve(ROC)of the modeling group was 0.755(95%CI:0.686-0.823),and differences between observed and predicted values were not deemed statistically significant via the Hosmer-Lemeshow test(χ^(2)=7.594,df=8,P=0.474).For validation group,the area under the ROC was 0.714(95%CI:0.561-0.867),and observed and predicted value differences were insignificant when assessed using the Hosmer-Lemeshow test(χ^(2)=7.735,df=8,P=0.460).The average tenfold cross-validation score was 0.716(0.507-0.841).Conclusions This study established a prediction model of postoperative adverse events after acute Stanford A aortic dissection.Variables used in the model were easy to obtain clinic

关 键 词：主动脉夹层 术后不良事件 危险因素 预测模型 

分 类 号：R543.16[医药卫生—心血管疾病]