心肺运动试验对冠心病PCI术后焦虑患者预后的预测价值分析  

Application of cardiopulmonary exercise to predict death in anxious patients after PCI for coronary heart disease

作　　者：覃梓瀚 陈瑞霖 李宇珊 任强 王艳霞 王圣熠 张伊 张权宇 QIN Zi-han;CHEN Rui-lin;LI Yu-shan;REN Qiang;WANG Yan-xia;WANG Sheng-yi;ZHANG Yi;ZHANG Quan-yu(Department of Cardiology,General Hospital,Northern Theater Command,Shenyang 110016,Liaoning,China;Second Cadet Regiment,School of Basic Medical Sciences,Air Force Medical University,Xi’an 710032,Shaanxi,China)

机构地区：[1]北部战区总医院心内科,辽宁沈阳1100161 [2]空军军医大学基础医学院学员二大队,陕西西安710032

出　　处：《心脏杂志》2023年第5期540-545,551,共7页Chinese Heart Journal

基　　金：国家自然科学基金项目(32071116);辽宁省科学技术计划项目(2022JH2/101500028);辽宁省科学技术计划项目(2020JH1/10300002)。

摘　　要：目的确定心肺运动试验(CPET)参数中与PCI术后存在焦虑的冠心病患者5年内死亡事件相关的独立危险因素,并建立此类人群5年死亡事件发生的预测模型。方法选取2015年10月~2021年9月北部战区总医院心血管内科因确诊冠心病(CAD)行PCI手术,且在出院前完成CPET的焦虑患者(GAD-7评分≥5)作为研究对象,最终符合条件共868例,其中根据5年内随访是否死亡分为死亡组17例,无事件组851例。应用单因素及多因素分析筛选出与5年死亡率相关的独立危险因素,建立Logistic回归模型,分别通过绘制受试者工作特征(ROC)曲线和Hosmer-Lemeshow拟合优度检验来评价预测模型预测效能和适配度。结果用力肺活量占预测百分比(FVC%)、二氧化碳通气当量的最小值(VE/VCO2min)和运动后心率恢复(HRR)(均P<0.05)等三个CPET参数是PCI术后存在焦虑的冠心病患者5年死亡风险独立危险因素。绘制ROC曲线,曲线下面积(area under curve,AUC)为0.795。Hosmer-Lemeshowχ2=7.396,P=0.495>0.1。结论尽管焦虑情绪对CPET结果的客观性存在一定影响,但个别CPET参数对PCI术后存在焦虑的冠心病患者的5年死亡事件的发生仍具有预测能力,这些参数在发生死亡事件的人群中明显趋向不良。AIM To determine the independent risk factors of cardiopulmonary exercise testing(CPET)related to death events within 5 years in coronary heart disease patients with anxiety after percutaneous coronary intervention(PCI)and to establish a prediction model for 5-year death events in such patients,so as to provide reference for the nursing and management of patients with coronary heart disease.METHODS Retrospective analysis was conducted of the data of 868 coronary artery disease(CAD)patients with anxiety(GAD-7 score≥5)who underwent PCI between October 2020 and September 2021 in the General Hospital of the Northern Theater Command.According to the results of a 5-year follow-up,17 cases were included in the adverse event group and 851 cases were included in the event-free group.The independent risk factors associated with death were screened out by applying univariate and multifactor analysis.Then,logistic regression models were established.The receiver operating characteristic(ROC)curve and Hosmer-Lemeshow goodness of fit test were used to evaluate the prediction efficiency and fitness of the prediction model.RESULTS Three CPET parameters including forced vital capacity percentage predicted(FVC%),minimum carbon dioxide ventilation equivalent(VE/VCO2min)and heart rate recovery after exercise(HRR)(all P<0.05)were independent risk factors for 5-year mortality risk in anxious CHD patients after PCI.The ROC curve was plotted and the area under the curve(AUC)was 0.903.Hosmer-Lemeshow was c2=7.396,P=0.495>0.1.CONCLUSION Although anxiety has certain effect on the objectivity of CPET results,some CPET parameters still have predictive power for the occurrence of 5-year death events in CHD patients with anxiety after PCI,and these parameters tend to be significantly worse in the population with death events.

关 键 词：冠心病 焦虑 经皮冠状动脉介入术 心肺功能运动试验 预测模型 危险因素 死亡率 

分 类 号：R541.4[医药卫生—心血管疾病]