急性心肌梗死后心力衰竭患者运动能力的影响因素及列线图预测模型的构建  

Influencing factors for exercise ability in patients with heart failure after acute myocardial infarction and the establishment of nomogram prediction model

作　　者：韦静 林桦[1] 李春燕 蒙玉民 黄小晶 罗雪 余湘宁[1] 宋静雯 WEI Jing;LIN Hua;LI Chunyan;MENG Yumin;HUANG Xiaojing;LUO Xue;YU Xiangning;SONG Jingwen(The First Ward of Cardiovascular Medicine Department,the First People′s Hospital of Nanning,Nanning 530016,Guangxi,China)

机构地区：[1]广西南宁市第一人民医院心血管内科一区,广西南宁市530016

出　　处：《广西医学》2023年第19期2335-2342,共8页Guangxi Medical Journal

基　　金：广西科技计划项目(桂科AB22080079);广西壮族自治区卫生健康委员会自筹经费科研课题(Z20210787)。

摘　　要：目的 探讨急性心肌梗死后心力衰竭患者运动能力及其影响因素,并构建列线图预测模型。方法 选择315例急性心肌梗死后心力衰竭患者作为研究对象,按调查先后顺序将其分为建模组221例和验证组94例。给予所有患者心肺运动试验,根据是否存在波浪式呼吸(OB)将建模组患者分为OB阳性组(n=85)和OB阴性组(n=136)。采用Logistic回归模型分析急性心肌梗死后心力衰竭患者运动能力的影响因素,基于影响因素构建列线图预测模型并进行验证。结果 315例急性心肌梗死后心力衰竭患者OB阳性率为39.37%。多因素Logistic回归分析结果显示,合并慢性病种类、体质指数、美国纽约心脏病学会(NYHA)心功能分级、中文版心脏病运动恐惧量表(TSK-Heart-C)评分、冠心病患者康复运动知信行问卷评分、中文版简化版疾病感知问卷(B-IPQ)评分是急性心肌梗死后心力衰竭患者运动能力的独立影响因素(P<0.05)。基于上述影响因素构建的列线图预测模型具有较好的区分度、校准度。决策曲线分析结果显示,当阈值概率分别为2%~88%、1%~95%时,该模型预测急性心肌梗死后心力衰竭患者运动能力的净获益值较高。结论 急性心肌梗死后心力衰竭患者运动能力较弱,合并慢性病种类、体质指数、NYHA心功能分级、TSK-Heart-C评分、冠心病患者康复运动知信行问卷评分、中文版B-IPQ评分是急性心肌梗死后心力衰竭患者运动能力的独立影响因素。基于上述影响因素构建的列线图预测模型有助于临床医师评估该人群的运动能力。Objective To explore the exercise ability and its influencing factors in patients with heart failure after acute myocardial infarction,and to establish a nomogram prediction model.Methods A total of 315 patients with heart failure after acute myocardial infarction were selected as the research subjects,and they were assigned to modeling group(221 cases)or validation group(94 cases)according to sequence of investigation.All patients received cardiopulmonary exercise testing,according to the presence of oscillatory breathing(OB),patients in the modeling group were divided into OB positive group(n=85)or OB negative group(n=136).The influencing factors for exercise ability in patients with heart failure after acute myocardial infarction were analyzed by using the Logistic regression model,and based on these influencing factors,the nomogram prediction model was established and validated.Results The positive rate of OB was 39.37%among 315 patients with heart failure after acute myocardial infarction.The results of multivariate Logistic regression analysis revealed that categories of concomitant chronic diseases,body mass index,New York Heart Association(NYHA)cardiac function classification,the Chinese version of Tampa Scale for Kinesiophobia Heart(TSK-Heart-C)score,score of knowledge-belief-practice questionnaire of rehabilitation exercise in patients with coronary heart disease,and Chinese version Brief Illness Perception Questionnaire(B-IPQ)score were the independent influencing factors for exercise ability in patients with heart failure after acute myocardial infarction(P<0.05).The nomogram prediction model established based on the aforementioned influencing factors exerted favorable discrimination and calibration.The results of decision curve analysis indicated that when the threshold probabilities were 2%-88%and 1%-95%,respectively,the net benefit value of the model in predicting exercise ability in patients with heart failure after acute myocardial infarction was relatively high.Conclusion The exercise ability of

关 键 词：急性心肌梗死 心力衰竭 运动能力 影响因素 预测模型 

分 类 号：R542.22[医药卫生—心血管疾病]