STEMI患者PCI术后近期发生主要不良心脑血管事件的中医预测模型构建及应用评估  

Construction of Traditional Chinese Medicine Prediction Model for Recent Occurrence of Major Adverse Cardiovascular and Cerebrovascular Events after PCI in STEMI Patients and Evaluation of Its Application

作　　者：王文丽[1] 吕玮坤 董欢乐 赵学飞[1] 陈敏娜[1] 张望[1] 邢雪 康启 董静[1] WANG Wenli;LYU Weikun;DONG Huanle;ZHAO Xuefei;CHEN Minna;ZHANG Wang;XING Xue;KANG Qi;DONG Jing(The Second Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,Shaanxi,China)

机构地区：[1]陕西中医药大学第二附属医院,陕西咸阳712000

出　　处：《现代中西医结合杂志》2023年第24期3387-3393,共7页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：陕西省重点研发计划项目(2020SF-277);咸阳市重点研发计划项目(2019K02-89)。

摘　　要：目的构建包含中医元素的急性ST段抬高型心肌梗死(STEMI)患者PCI术后近期发生主要不良心脑血管事件(MACCE)的预测模型,并评价其预测准确性以及临床有效性。方法选取2018年1月1日—2021年12月31日于陕西中医药大学第二附属医院行急诊PCI治疗的STEMI患者,所有患者均随访1年,剔除中间失访患者,根据患者随访期间是否发生MACCE,分为MACCE组121例和非MACCE组200例。通过多因素Logistic分析导致STEMI患者PCI术后近期发生MACCE的独立危险因素,基于上述独立危险因素利用R语言构建列线图模型,利用Bootstrap法验证构建模型的预测准确性,利用受试者工作曲线(ROC)验证构建的临床模型的预测效能,利用临床获益曲线(DCA)评价构建的预测模型的临床获益性。结果多因素Logistics分析显示,导致STEMI患者PCI术后近期发生MACCE的独立危险因素为气虚血瘀、细弱脉、少苔、年龄、糖尿病史、吸烟史、低密度脂蛋白胆固醇(LDL-C)高、植入支架≥3枚。基于上述独立危险因素构建的列线图预测模型,其ROC曲线验证显示其预测能力较强,ROC曲线下面积为0.87,95%CI(0.72~0.92);Bootstrap法验证构建模型相关数据显示其构建模型的预测准确性较好:C-index 0.879(95%CI:0.812~0.932);Calibration plot预测STEMI患者PCI术后近期发生MACCE的风险与实际发生MACCE风险的平均绝对误差为0.012;Hosmer-Lemeshow检验结果显示χ^(2)=6.062,P=0.623;DCA曲线显示当MACCE发生阈值为0.10~0.98时该模型的临床获益性以及适用性最佳。结论气虚血瘀、细弱脉、少苔、年龄、糖尿病史、LDL-C高、吸烟史、植入支架≥3枚是导致STEMI患者PCI术后近期发生MACCE的独立危险因素,基于上述独立危险因素构建的列线图模型具有较高的预测准确性和临床适用性。Objective It is to construct a prediction model of major adverse cardiovascular and cerebrovascular events(MACCE)occurred in the near future after PCI in patients with acute ST-segment elevation myocardial infarction(STEMI)containing elements of traditional Chinese medicine(TCM),and to evaluate its prediction accuracy as well as clinical validity.Methods The STEMI patients who underwent emergency PCI at the Second Affiliated Hospital of Shaanxi University of Chinese Medicine from January 1,2018 to December 31,2021 were selected,and followed up for 1 year,the lost patients during following up were excluded,and the remaining patients were divided into MACCE group(n=121)and non-MACCE group(n=200)according to whether MACCE occurred during the patients’follow-up.The independent risk factors leading to the recent occurrence of MACCE after PCI in STEMI patients were analyzed by multifactorial Logistic analysis,and a column-line graph model was constructed based on the above independent risk factors by R language,the predictive accuracy of the constructed model was verified by Bootstrap method,the predictive efficacy of the constructed clinical model was verified by receiver operating characteristic(ROC)curve,and the clinical benefit of the constructed model was evaluated by the clinical benefit curve(DCA).The clinical benefit of the constructed prediction model was evaluated by decision curve analysis.Results Multifactorial Logistic analysis showed that the independent risk factors leading to recent MACCE after PCI in STEMI patients were Qi deficiency and blood stasis,thready and weak pulse,less moss,age,history of diabetes mellitus,history of smoking,high low-density lipoprotein cholesterol(LDL-C),and implanted stents≥3.The validation of the ROC curve of the column-line graph prediction model constructed based on the above independent risk factors showed that it had strong predictive ability,and the area under the ROC curve was 0.87,with a 95%CI(0.72~0.92).The related data of the constructed model verified by Boots

关 键 词：中医证候 急性心肌梗死 经皮冠状动脉介入治疗 列线图模型 主要不良心脑血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]