脂蛋白相关磷脂酶A2联合D-二聚体与纤维蛋白原比值构建急性心肌梗死经皮冠状动脉介入术后患者预后列线图模型  

Lipoprotein-associated phospholipase A2 combined with D-dimer to fibrinogen ratio to construct a prognostic nomogram model for patients with acute myocardial infarction after percutaneous coronary intervention

作　　者：彭祥旺 曹繁 杨明[1] 霍秋玉[1] Peng Xiangwang;Cao Fan;Yang Ming;Huo Qiuyu(Department of Emergency,BenQ Hospital Affiliated to Nanjing Medical University,Nanjing 210019,China)

机构地区：[1]南京医科大学附属明基医院急诊科,南京210019

出　　处：《中国医师进修杂志》2023年第7期615-621,共7页Chinese Journal of Postgraduates of Medicine

摘　　要：目的:通过脂蛋白相关磷脂酶A2(Lp-PLA2)及D-二聚体与纤维蛋白原比值(D/F)等指标构建急性ST段抬高型心肌梗死(STEMI)经皮冠状动脉介入(PCI)术后患者预后列线图模型并评估其预测价值。方法:回顾性连续选取2017年1月至2020年1月南京医科大学附属明基医院收治的291例急性STEMI患者,收集所有患者PCI术前的临床资料,包括但不限于Lp-PLA2以及D/F。采用受试者工作特征(ROC)曲线与多因素Logistic回归分析STEMI患者PCI术后90 d内死亡危险因素,绘制Kaplan-Meier生存曲线比较不同Lp-PLA2及D/F分组患者的生存情况,利用R语言软件构建列线图模型及决策曲线。结果:LpPLA2及D/F预测急性STEMI患者PCI术后90 d因心因死亡风险的曲线下面积分别为0.896(95%CI 0.850~0.932)和0.884(95%CI 0.837~0.922);其最佳截断值分别为59.50μg/L和0.46(P<0.05);LpPLA2>59.50μg/L患者心因病死率明显高于LpPLA2≤59.50μg/L患者,D/F>0.46患者心因病死率明显高于D/F≤0.46患者,差异有统计学意义(P<0.05);年龄(>66岁)、左心室射血分数(≤45%)、LpPLA2(>59.50μg/L)、D/F(>0.46)、N-末端脑钠肽前体(>1.55μg/L)以及空腹血糖(FBG)(>7.00 mmol/L)是急性STEMI患者PCI术后90 d因心因死亡风险(P<0.05);当风险阈值分别>0.24时,列线图模型可提供显著附加的临床净收益。结论:Lp-PLA2及D/F与急性STEMI患者PCI术后预后密切相关,联合其他临床指标所构建出的列线图模型可有效预测其PCI术后90 d内死亡风险。Objective To construct acute ST-segment elevation myocardial infarction(STEMI)percutaneous coronary intervention(PCI)by using lipoprotein-associated phospholipase A2(Lp-PLA2)and D-dimer to fibrinogen ratio(D/F)and other indicators postoperative patient prognosis nomogram model and evaluation of its predictive value.Methods A total of 291 acute STEMI patients admitted to the BenQ Hospital Affiliated to Nanjing Medical University from January 2017 to January 2020 were retrospectively selected,including but not limited to Lp-PLA2 and D/F,were collected.Receiver operating characteristic(ROC)curve and multivariate Logistic regression were used to analyze the risk factors of death within 90 d after PCI in STEMI patients,and Kaplan-Meier survival curves were drawn to compare the survival of patients in different Lp-PLA2 and D/F groups.The R language software was used to build nomogram model and decision curve.Results The AUCs of LpPLA2 and D/F for predicting the risk of death from cardiac causes at 90 s after PCI in patients with acute STEMI were 0.896(95%CI 0.850 to 0.932)and 0.884(95%CI 0.837 to 0.922),respectively.The values were 59.50μg/L and 0.46 respectively(P<0.05);the mortality rates of acute STEMI patients in LpPLA2>59.50μg/L and D/F>0.46 groups after PCI were higher than those in LpPLA2≤59.50μg/L group and D/F≤0.46 group(P<0.05);age(>66 years),left ventricular ejection fraction(LVEF)(≤45%),LpPLA2(>59.50μg/L),D/F(>0.46),N-terminal brain natriuretic peptide precursor(>1.55μg/L)and fasting blood glucose(>7.00 mmol/L)were the risk of death from cardiac causes at 90 d after PCI in patients with acute STEMI(P<0.05);when the risk thresholds were>0.24,the nomogram model could provide significant additional net clinical benefit.Conclusions Lp-PLA2 and D/F are closely related to the prognosis of patients with acute STEMI after PCI,and the nomogram model constructed in combination with other clinical indicators can effectively predict the risk of death within 90 d after PCI.

关 键 词：ST段抬高型心肌梗死 经皮冠状动脉介入疗法 脂蛋白相关磷脂酶A2 D-二聚体与纤维蛋白原比值 

分 类 号：R542.22[医药卫生—心血管疾病]