排除国际标准化比值的终末期肝病模型评分对急性心肌梗死后室间隔穿孔患者行经皮介入封堵术后预后的预测价值  

Value of model for end-stage liver disease excluding international normalized ratio to the prediction of prognosis of post-myocardial infarction ventricular septal rupture after percutaneous transcatheter closure

作　　者：王志伟[1] 王真真 刘畅 王琰 陈同峰[3] 郭晓艳 程江涛[3] WANG Zhi-wei;WANG Zhen-zhen;LIU Chang;WANG Yan;CHEN Tong-feng;GUO Xiao-yan;CHENG Jiang-tao(Department of Cardiology,Henan University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China;Department of Cardiology,the First Af filiated Hospital of Henan University,Kaifeng,Henan 475000,China;Department of Structural Heart Disease,Heart Center of Henan Provincial People's Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou,Henan 451464,China)

机构地区：[1]河南大学人民医院、河南省人民医院心内科,河南郑州州450003 [2]河南大学第一附属医院心内科,河南开封475000 [3]河南省人民医院心脏中心、阜外华中心血管病医院结构性心脏病科,河南郑州451464

出　　处：《中华实用诊断与治疗杂志》2023年第2期156-161,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200092)。

摘　　要：目的观察急性心肌梗死(acute myocardial infarction,AMI)后室间隔穿孔(ventricular septal rupture,VSR)患者排除国际标准化比值的终末期肝病模型(model for end-stage liver disease excluding international normalized ratio,MELD-XI)评分情况,探讨其对AMI后VSR患者行经皮介入封堵术后预后的预测价值。方法66例AMI后VSR患者均行经皮介入封堵术,记录基础疾病、吸烟史、VSR位置、VSR直径、VSR至封堵时间及病变血管、再灌注治疗、心源性休克、应用主动脉内球囊反搏、使用血管活性药物情况,血浆N末端脑钠肽前体、C反应蛋白、总胆红素、血肌酐水平及超声心动图检查结果等,计算MELD-XI评分。出院后随访3年,记录患者生存情况。根据术后30 d内生存情况分为生存组56例和死亡组10例,比较2组临床资料。采用多因素logistic回归分析AMI后VSR患者行经皮介入封堵术后30 d内死亡的影响因素;绘制ROC曲线,评估MELD-XI评分预测AMI后VSR患者行经皮介入封堵术后30 d内死亡的效能;采用Hosmer-Lemeshow拟合优度检验评价预测模型的校准能力;以MELD-XI评分最佳截断值(15分)为界,将66例患者分为高MELD-XI评分组(>15分)14例和低MELD-XI评分组(≤15分)52例,绘制Kaplan-Meier生存曲线,比较高、低MELD-XI评分组术后3年生存率。结果66例患者随访1 d~3年,30 d内死亡10例(15.2%);随访3年期间死亡16例,失访5例,术后3年生存率为73.8%。死亡组VSR至封堵时间[17(15,20)d]短于生存组[23(17,31)d](U=-2.633,P=0.008),再灌注治疗比率(0)、左室射血分数[(46.2±10.4)%]均低于生存组[50.0%、(51.8±7.6)%](χ^(2)=6.758,P=0.009;t=-2.011,P=0.048),心源性休克比率(90.0%)、MELD-XI评分[16(11,32)分]及血浆N末端脑钠肽前体[10178(6429,22208)ng/L]、C反应蛋白[69.0(37.6,174.9)mg/L]水平均高于生存组[33.9%、11(9,14)分、4490(2091,8774)ng/L、12.3(5.8,35.8)mg/L](P<0.05),高血压、糖尿病、高脂血症、既往冠心病、吸烟、VSR位置、�Objective To observe the scoring of model for end-stage liver disease excluding international normalized ratio(MELD-XI)in patients with post-myocardial infarction ventricular septal rupture(VSR),and to investigate its value to the prediction of prognosis of patients with post-myocardial infarction VSR after percutaneous transcatheter closure.Methods Sixty-six patients with post-myocardial infarction VSR underwent percutaneous transcatheter closure.The underlying disease,smoking history,VSR location,VSR diameter,time from VSR to closure,diseased vessel,reperfusion therapy,cardiogenic shock,application of intra-aortic balloon pump,use of vasoactive drugs,plasma N-terminal pro-brain natriuretic peptide,C-reactive protein,total bilirubin,serum creatinine,and echocardiography results were recorded,and the MELD-XI score was calculated.The follow-up survey was performed for 3 years after discharge and the survival was recorded.The patients were divided into survival group(n=56)and death group(n=10)according to the survival within 30 d after closure.Multivariate logistic regression was used to analyze the influencing factors of death within 30 d after closure in patients with post-myocardial infarction VSR.ROC curves were plotted to assess the efficiency of MELD-XI score on predicting death within 30 d after closure.Hosmer-Lemeshow goodness-of-fit test was done to evaluate the calibration ability of the prediction model.With the optimal cut-off value of MELD-XI score(15)as the boundary,66 patients were divided into 14 patients with MELD-XI>15(high MELD-XI group)and 52 patients with MELD-XI≤15(low MELD-XI group).Kaplan-Meier method was used to compare the 3-year survival rate after closure between high and low MELD-XI groups.Results Sixty-six patients were followed up for 1 day to 3 years,10(15.2%)died within 30 d,and 16 died in 3 years of follow-up,and 5 were lost,with the 3-year survival rate of 73.8%.The time from VSR to closure was shorter in death group[17(15,20)d]than that in survival group[23(17,31)d](U=-2.633,P=

关 键 词：急性心肌梗死 室间隔穿孔 排除国际标准化比值的终末期肝病模型评分 经皮介入封堵术 预后 

分 类 号：R542.22[医药卫生—心血管疾病]