急性ST段抬高型心肌梗死合并心脏破裂的列线图模型建立  

Establishment of nomogram model of acute ST-segment elevation myocardial infarctionwith cardiac rupture

作　　者：吴鹏[1] 严宁[2] 马娟[1] 王墨函 贾绍斌[2] 马学平 WU Peng;YAN Ning;MA Juan;WANG Mohang;JIA Shaobin;MA Xueping(Graduate School of Ningxia Medical University,Yinchuan,Ningxia 750004,China;Department of Cardiology,General Hospital of Ningxia Medical University,Yinchuan,Ningxia 750004,China)

机构地区：[1]宁夏医科大学研究生院,宁夏银川市750004 [2]宁夏医科大学总医院心血管内科,宁夏银川市750004

出　　处：《中国动脉硬化杂志》2024年第5期415-423,共9页Chinese Journal of Arteriosclerosis

基　　金：宁夏回族自治区重点研发计划(2020BFG02002);宁夏自然科学基金项目(2023AAC02069)。

摘　　要：[目的]分析急性ST段抬高型心肌梗死(STEMI)患者发生心脏破裂(CR)的风险因素,并依此构建急性STEMI患者合并CR的列线图模型。[方法]通过宁夏医科大学总医院大数据研究平台、医院信息系统检索连续纳入2015年1月—2019年12月急性STEMI患者5412例,其中合并CR的91例患者为CR组,5321例未合并CR患者为非CR组。运用LASSO回归、单因素及多因素Logistic回归分析急性STEMI患者合并CR的风险因素,并建立CR的列线图预测模型。分别运用受试者工作特征曲线、Hosmer-Lemeshow检验、临床决策曲线分析法(DCA)对建立的列线图模型进行验证和评估。[结果]LASSO回归结果显示年龄、女性、高血压病史、首次医疗接触时间、休克指数、Killip分级、白细胞计数、D二聚体、乳酸、前壁心肌梗死、24 h内服用β受体阻滞剂、24 h内服用血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)药物、急诊PCI共13个变量为CR的风险因素(P<0.05)。把筛选出的13个风险因素分别进行单因素及多因素Logistic回归分析,结果提示年龄、Killip分级、首次医疗接触时间、白细胞计数、未行急诊PCI、24 h内未服用ACEI/ARB药物是急性STEMI患者合并CR的风险因素。依据上述6个风险变量建立急性STEMI合并CR列线图模型。该列线图模型内部验证前后ROC曲线下面积分别为0.946(95%CI:0.927~0.961)、0.947(95%CI:0.927~0.959),灵敏度分别为0.957、0.904,特异度分别为0.858、0.876,说明该模型具有较好的区分度。运用Hosmer-Lemeshow检验证明该模型的预测价值和实际观测值之间的偏差没有统计学意义(χ^(2)=12.70,P=0.122),说明列线图模型具有较好的校准度。DCA曲线提示模型的预测概率阈值在0.00~0.40之间,临床净获益最高,说明具有较好的临床效能。[结论]本研究建立的列线图模型有较好的区分度、校准度和临床效能,能有效预测急性STEMI合并CR的发生概率,为临床诊Aim To analyze the risk factor of the cardiac rupture(CR)in patients with acute ST-segment eleva-tion myocardial infarction(STEMI).Based on this,the nomogram model of acute STEMI patients with CR was estab-lished.Methods Through Ningxia Medical University General Hospital's big data research platform and hospital in-formation system retrieval,5412 patients with acute STEMI from January 2015 to December 2019 were continuously includ-ed in the study,of which 91 patients with CR were included as CR group;5321 patients non-combined with CR were in-cluded as non-CR group.LASSO regression,univariate and multivariate Logistic regression were used to analyze the risk factors of CR in patients with acute STEMI,and the CR nomogram predictive model was established.The nomogram mod-el was validated and evaluated by using receiver operating characteristic(ROC)curve,Hosmer-Lemeshow test and clinical decision curve analysis(DCA).Results LASSO regression results showed that age,female,hypertension history,first medical contact time,shock index,Killip grade,white blood cell count,d-dimer,lactic acid,anterior myocardial in-farction,β-blocker administration within 24 hours,angiotensin converting enzyme inhibitor/angiotensin receptor antagonist(ACEI/ARB)administration within 24 hours,emergency percutaneous coronary intervention(PCI)were 13 risk factors of CR(P<0.05).The screened 13 risk factors were analyzed by univariate and multivariate Logistic regression,the results suggested that age,Killip grade,first medical contact time,white blood cell count,not undergoing emergency PCI and not taking ACEI/ARB drugs within 24 hours were the risk factors of CR in patients with acute STEMI.The acute STEMI with CR nomogram model was established according to the above 6 risk variables.The area under the ROC curve before and after the internal verification of the nomogram model was 0.946(95%CI:0.927~0.961),0.947(95%CI:0.927~0.959),and the sensitivity was 0.957 and 0.904,respectively,the specificity was 0.858 and 0.876,respectively,which indicat

关 键 词：急性ST段抬高型心肌梗死 心脏破裂 风险因素 列线图 

分 类 号：R5[医药卫生—内科学]