基于胸痛中心数据库急性非ST段抬高型心肌梗死早期诊断模型的构建  

Construction of an early diagnosis model for acute non-ST-segment elevation cardiac infarction based on chest pain center database

作　　者：李勇[1] 肖子亚 王新艳[1] 张亚斌[1] 李腾[1] 徐鑫 师猛[1] 郭向杰[1] Li Yong;Xiao Ziya;Wang Xinyan;Zhang Yabin;Li Teng;Xu Xin;Shi Meng;Guo Xiangjie(Department of Emergency,Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]山东省济宁医学院附属医院急诊科,济宁272029

出　　处：《中国循证心血管医学杂志》2023年第4期443-446,452,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：山东省医药卫生科技发展计划资助项目(202010000964)。

摘　　要：目的 基于胸痛中心数据库,构建急性非ST段抬高型心肌梗死(NSTEMI)的早期诊断模型。方法 回顾性收集2020年1月至2020年12月就诊于山东省济宁医学院附属医院急诊胸痛中心的患者临床资料,按照是否诊断NSTEMI将患者分为NSTEMI组(n=154)和非NSTEMI组(n=2098)。对两组患者的临床相关指标进行比较,将两组间有统计学差异的研究指标纳入多因素Logistic回归分析,并建立NSTEMI早期诊断列线图模型;绘制模型的受试者工作特征(ROC)曲线以评估预测准确度,利用Homser-Lemeshow统计量对模型进行拟合优度检验。结果 共纳入2252例患者,其中确诊的NSTEMI患者154例(6.84%)。多因素分析显示,24 h内心绞痛发作≥2次、冠状动脉粥样硬化性心脏病(冠心病)史、心前区压榨样疼痛、伴剑突下不适、肌酸激酶同工酶(CK-MB)升高、肌钙蛋白I(cTnI)升高和心电图ST段压低是胸痛患者诊断NSTEMI的独立因素(P<0.05)。进一步构建列线图模型,ROC曲线分析显示,列线图模型预测急性胸痛患者NSTEMI风险的曲线下面积为0.997(P<0.01),特异度为97.38%,灵敏度为98.70%。采用Homser-Lemeshow进行拟合优度检验,表明所构建的急性胸痛患者诊断NSTEMI的列线图模型可以很好的拟合(χ^(2)=1.713,P=0.989)。结论 基于山东省济宁医学院附属医院胸痛中心数据库我们构建了急性胸痛患者诊断NSTEMI的列线图模型,本模型具有较好的灵敏度和特异度,为胸痛患者NSTEMI的早期诊断提供了新的辅助工具。Objective An early diagnosis model of acute non-ST segment elevation cardiac infarction(NSTEMI)was established based on the chest pain center database.Methods Clinical data of patients who attended the emergency chest pain center in Affiliated Hospital of Jining Medical University of Shandong Province from January 2020 to December 2020 were retrospectively collected.Patients were divided into the NSTEMI group and the non-NSTEMI group according to whether or not NSTEMI was diagnosed.The clinical-related indicators of the two groups were compared.Th nomogram model of NSTEMI early diagnosis was established.The research indicators with statistical differences between the two groups were included in multivariate Logistic regression analysis,and the early diagnosis of the NSTEMI nomogram model was established.The receiver operating characteristic(ROC)curve of the model was used to evaluate the prediction accuracy,and the Homser-Lemeshow statistics were used to test the goodness of fit for the model.Results According to inclusion and exclusion criteria,a total of 2252 patients were included of which 154(6.84%)were diagnosed with NSTEMI.Multivariate analysis showed that two or more angina attacks within 24 hours,history of coronary heart disease,precardiac crush pain,subxiphoid discomfort,increased creatine kinase isoenzyme(CK-MB),increased troponin I(cTnI)and ECG ST segment depression were independent factors for the diagnosis of NSTEMI in patients with chest pain(P<0.05),and the nomogram model was constructed.ROC curve analysis showed that the area under the curve for predicting the risk of NSTEMI in patients with acute chest pain was 0.997(P<0.01),the specificity was 97.38%,and the sensitivity was 98.70%.The result of Homser-lemeshow was used to test the goodness of fit,which shows that the model can be fitted well(χ^(2)=-1.713,P=0.989).Conclusions Based on the database of chest pain center in Affiliated Hospital of Jining Medical University of Shandong Province,this study constructed a nomogram model for the diagnos

关 键 词：非ST段抬高型心肌梗死 早期诊断 列线图 

分 类 号：R542.22[医药卫生—心血管疾病]