联合指标预测模型对心肌梗死后心源性休克患者院内死亡的预测价值  

The value of combined index prediction model in predicting hospital death in patients with cardiogenic shock after myocardial infarction

作　　者：张志宇 王世鹏 刘俊倩 郭霞 王宇石[1] ZHANG Zhiyu;WANG Shipeng;LIU Junqian;GUO Xia;WANG Yushi(Department of Cardiology,The First Hospital of Jilin University,Changchun,130021,China)

机构地区：[1]吉林大学第一医院心内科,长春130021

出　　处：《临床心血管病杂志》2023年第7期508-515,共8页Journal of Clinical Cardiology

摘　　要：目的:探讨急性心肌梗死(AMI)后心源性休克(CS)患者院内死亡的危险因素以及联合指标预测模型对AMI后CS患者院内死亡的预测价值。探讨联合指标预测模型、主动脉内球囊反搏-休克(IABP-SHOCKⅡ)评分、心源性休克预后(CSP)评分对行经皮冠状动脉介入术(PCI)的AMI后CS患者院内死亡的预测价值。方法:收集2019年1月—2022年11月于吉林大学第一医院心内科治疗的AMI后CS患者271例,根据院内存活情况将患者分为死亡组(90例)与存活组(181例),分析患者院内死亡的独立影响因素,并构建联合指标预测模型,用受试者工作特性曲线(ROC)和曲线下面积(AUC)评估联合指标预测模型、单个独立因素、CSP评分的预测价值,最后比较不同指标的AUC。从271例AMI后CS患者中筛选出199例接受PCI的患者,分为PCI死亡组(49例)与PCI存活组(150例),用ROC以及AUC评估联合指标预测模型、IABP-SHOCKⅡ、CSP、IABP-SHOCKⅡ+CSP评分的预测价值,最后再比较不同评分的AUC大小。结果:单因素分析显示,两组在意识不清、左室射血分数(LVEF)、机械并发症、白细胞绝对值(WBC)、中性粒细胞绝对值(NE)、单核细胞绝对值(MO)、酸碱度(pH)、乳酸(LAC)、碱剩余(BE)、门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、直接胆红素(DBIL)、白蛋白(ALB)、血尿素氮(BUN)、血肌酐(Scr)、估测肾小球滤过率(eGFR)、B型脑钠肽(BNP)、两种以上血管活性药物、连续性肾脏替代治疗(CRRT)、有创呼吸机辅助通气、成功再灌注、CSP评分上均差异有统计学意义(均P<0.05)。多因素回归分析显示,机械并发症(OR=6.824,P<0.001)、LAC(OR=1.125,P=0.006)、Scr(OR=1.005,P=0.013)、两种及以上血管活性药物(OR=5.163,P<0.001)、有创呼吸机辅助通气(OR=2.823,P=0.004)是AMI后CS患者院内死亡的独立危险因素;成功再灌注(OR=0.190,P<0.001)是独立保护因素。在AMI后CS的患者中,联合指标预测模型、CSP评分的AUC�Objective To explore the risk factors of hospital death in patients with cardiogenic shock(CS) after acute myocardial infarction(AMI), to determine the value of combined index prediction model in predicting hospital death in patients with CS after AMI. To explore the predictive value of combined index prediction model, intra-aortic balloon counterpulsation-shock Ⅱ(IABP-SHOCK Ⅱ) score, and cardiogenic shock prognosis(CSP) score in hospital death of CS patients with percutaneous coronary intervention(PCI) after AMI.Methods A total of 271 patients with CS after AMI, who were treated in the Department of Cardiology of the First Hospital of Jilin University from January 2019 to November 2022, were collected. All patients were divided into the death group(n=90) and the survival group(n=181) according to their in-hospital survival. The independent influencing factors of in-hospital death were analyzed and a combined index prediction model was established. The predictive value of combined index prediction model, single independent factor, and CSP score was evaluated by the receiver operating characteristic(ROC) curve and area under curve(AUC). Finally, the AUC of different indexes were compared. From 271 patients with CS after AMI, 199 patients with PCI were selected and divided into the PCI death group(n=49) and the PCI survival group(n=150). The predictive value of combined index predictive model, IABP-SHOCK Ⅱ, CSP, and IABP-SHOCK II+CSP score was evaluated by ROC and AUC, and the AUC of different scores were compared.Results Univariate analysis showed that there were significant differences in unconsciousness, left ventricular ejection fraction(LVEF), mechanical complications, white blood cell(WBC), neutrophil absolute value(NE), monocyte absolute value(MO), pH, lactic acid(LAC), base excess(BE), aspartate aminotransferase(AST), alanine aminotransferase(ALT), direct bilirubin(DBIL), albumin(ALB), blood urea nitrogen(BUN), serum creatinine(Scr), estimated glomerular filtration rate(eGFR), B-type brain natriuretic

关 键 词：急性心肌梗死 心源性休克 主动脉内球囊反搏-休克Ⅱ评分 心源性休克预后评分 

分 类 号：R542.2[医药卫生—心血管疾病]