成人先天性心脏病伴肺动脉高压患者介入术后严重不良事件风险预测模型构建及验证  

Construction and validation of risk prediction model for serious adverse events in adult patients with congenital heart disease complicated with pulmonary hypertension after cardiac catheterization

作　　者：胡娟舟 张迎红[1] 张文[2] 黄静 刘佳[1] 彭盼 HU Juanzhou;ZHANG Yinghong;ZHANG Wen;HUANG Jing;LIU Jia;PENG Pan(Medical College,Wuhan University of Science and Technology,Wuhan,430065,P.R.China;Department of Cardiovascular Surgery,Wuhan Asian Heart Hospital Affiliated to Wuhan University of Science and Technology,Wuhan,430065,P.R.China;Department of Cardiovascular Surgery,Wuhan Puren Hospital,Wuhan,430065,P.R.China)

机构地区：[1]武汉科技大学医学院,武汉430065 [2]武汉科技大学附属武汉市亚洲心脏病医院心血管外科,武汉430065 [3]武汉市普仁医院心血管外科,武汉430065

出　　处：《中国胸心血管外科临床杂志》2024年第5期768-775,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：湖北省健康委员会联合基金项目(WJ2019H345)。

摘　　要：目的构建成人先天性心脏病(adult congenital heart disease,ACHD)合并肺动脉高压(pulmonary hypertension,PH)患者心导管介入术后严重不良事件(serious adverse event,SAE)风险预测评分模型,并验证其预测效果。方法回顾性纳入2018年1月—2022年1月于武汉科技大学附属武汉市亚洲心脏病医院接受心导管介入术合并PH的ACHD患者。按照入院时间先后顺序将患者按照7∶3的比例随机分为模型组和验证组。模型组按介入术后是否发生SAE分为SAE组和非SAE组,对两组资料进行比较,根据多因素logistic回归分析结果建立风险预测模型。分别采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积和HosmerLemeshow检验对模型的区分度和校准度进行评价。结果共纳入758例患者,其中男240例(31.7%)、女518例(68.3%),平均年龄43.1(18.0~81.0)岁。模型组530例(SAE组47例,非SAE组483例),验证组228例。单因素分析显示SAE组和非SAE组年龄、吸烟史、瓣膜病史、心力衰竭病史、N末端B型利钠肽原等差异有统计学意义(P<0.05)。多因素分析显示年龄≥50岁、心力衰竭病史、中重度先天性心脏病、中重度PH、心导管介入检查并治疗、手术全身麻醉以及N末端B型利钠肽原≥126.65 pg/mL是ACHD-PH患者心导管介入术后SAE的危险因素(P<0.05)。风险预测评分模型总分为0~139分,分值>50分为高危人群。模型验证结果显示ROC曲线下面积为0.937[95%CI(0.897,0.976)]。Hosmer-Lemeshow拟合优度检验:χ^(2)=3.847,P=0.797。结论患者年龄≥50岁、心力衰竭病史、中重度先天性心脏病、中重度PH、心导管介入检查并治疗、手术全身麻醉以及N末端B型利钠肽原≥126.65 pg/mL是ACHD-PH患者心导管介入术后发生SAE的危险因素。基于这些因素构建的风险预测模型具有较高的预测价值,可应用于ACHD-PH患者介入术后发生SAE的风险评估,以帮助临床医护人员进行早期干预。Objective To construct a risk prediction score model for serious adverse event(SAE)after cardiac catheterization in patients with adult congenital heart disease(ACHD)and pulmonary hypertension(PH)and verify its predictive effect.Methods The patients with PH who underwent cardiac catheterization in Wuhan Asian Heart Hospital Affiliated to Wuhan University of Science and Technology from January 2018 to January 2022 were retrospectively collected.The patients were randomly divided into a model group and a validation group according to the order of admission.The model group was divided into a SAE group and a non-SAE group according to whether SAE occurred afterthe catheterization.The data of the two groups were compared,and the risk prediction score model was establishedaccording to the results of multivariate logistic regression analysis.The discrimination and calibration of the model wereevaluated using the area under the receiver operating characteristic(ROC)curve and the Hosmer-Lemeshow test,respectively.Results A total of 758 patients were enrolled,including 240(31.7%)males and 518(68.3%)females,with amean age of 43.1(18.0-81.0)years.There were 530 patients in the model group(47 patients in the SAE group and 483patients in the non-SAE group)and 228 patients in the validation group.Univariate analysis showed statistical differencesin age,smoking history,valvular disease history,heart failure history,N-terminal pro-B-type natriuretic peptide,and otherfactors between the SAE and non-SAE groups(P<0.05).Multivariate analysis showed that age≥50 years,history of heartfailure,moderate to severe congenital heart disease,moderate to severe PH,cardiac catheterization and treatment,surgicalgeneral anesthesia,and N-terminal pro-B-type natriuretic peptide≥126.65 pg/mL were risk factors for SAE after cardiaccatheterization for ACHD-PH patients(P<0.05).The risk prediction score model had a total score of 0-139 points andpatients who had a score>50 points were high-risk patients.Model validation results showed an area under

关 键 词：成人先天性心脏病 肺动脉高压 介入术 严重不良事件 风险预测模型 

分 类 号：R541.1[医药卫生—心血管疾病] R544.1[医药卫生—内科学]