急性心肌梗死溶栓治疗结局的预警因素及危险分层系统的建立  

Early warning factors and establishment of risk stratification system for the outcome of thrombolytic therapy in acute myocardial infarction

作　　者：陈春英 姚亚飞 仇梦悦 曹文昊 CHEN Chun-ying;YAO Ya-fei;QIU Meng-yue;CAO Wen-hao(Department of Cardiology,Kaifeng Third People's Hospital(Kaifeng Xiangfu District First People's Hospital),Kaifeng 475100,Henan,CHINA)

机构地区：[1]开封市第三人民医院(开封市祥符区第一人民医院)心血管内科,河南开封475100

出　　处：《海南医学》2024年第9期1223-1227,共5页Hainan Medical Journal

基　　金：2020年河南省医学科技攻关计划(联合共建)项目(编号:LHGJ20201092)。

摘　　要：目的探讨急性心肌梗死(AMI)溶栓治疗结局预警因素,建立危险分层系统,为后续溶栓治疗决策提供参考依据。方法选取2020年1月至2022年12月开封市第三人民医院(开封市祥符区第一人民医院)收治的200例AMI患者纳入研究,遵循7∶3比例分为训练集(n=140)和验证集(n=60),训练集和验证集各46例、21例溶栓失败,94例、39例溶栓成功,分别纳入溶栓成功组和溶栓失败组。统计训练集、验证集中溶栓成功组和溶栓失败组的一般资料、实验室指标等,采用多因素Logistic回归方程分析AMI溶栓治疗结局预警因素,并建立危险分层系统。结果训练集和验证集中,溶栓失败组患者的LVEF明显低于溶栓成功组,GRACE评分、NT-proBNP、sFas、Caspasec-3、sTRAIL、高血压明显高于溶栓成功组,差异均有统计学意义(P<0.05);LVEF、GRACE评分、NT-proBNP、sFas、Caspasec-3、sTRAIL、高血压容差为0.320~0.520,VIF为1.900~3.115,多重共线性可能性低;多因素Logistic回归方程分析结果显示,LVEF、NT-proBNP、sFas、Caspasec-3、GRACE评分、sTRAIL、高血压均是AMI患者溶栓失败影响因素(P<0.05);验证集、训练集人群中,高危患者溶栓失败率为21.43%、30.00%,低危患者溶栓失败率分别为11.43%、5.00%,且训练集和验证集的Pearson列联系数分别为0.370、0.400。结论AMI溶栓治疗结局预警因素涉及LVEF、GRACE评分、NT-proBNP、sFas、Caspasec-3、高血压,据此建立危险分层系统有助于指导溶栓治疗决策,使更多患者获益。Objective To explore the early warning factors for the outcome of thrombolytic therapy in acute myocardial infarction(AMI),and to establish a risk stratification system,in order to provide reference basis for subsequent thrombolytic treatment decisions.Methods A total of 200 AMI patients admitted to Kaifeng Third People's Hospital(Kaifeng Xiangfu District First People's Hospital)from January 2020 to December 2022 were selected for the study.They were divided into a training set(n=140)and a validation set(n=60)in a 7:3 ratio.Forty-six cases in the training set and 21 cases in the validation set failed in thrombolysis(failed thrombolysis group),while 94 cases in the training set and 39 cases in the validation set were successful in thrombolysis(successful thrombolysis group).The general information and laboratory indicators of the successful and failed thrombolysis groups in the training sets and validation sets were analyzed.Multiple logistic regression equations were used to analyze the warning factors for thrombolysis treatment outcomes of AMI,and a risk stratification system was established.Results In the training and validation sets,the LVEF of patients in the failed thrombolysis group was significantly lower than that in the successful thrombolysis group;the GRACE score,NT proBNP,sFas,Caspasec-3,sTRAIL,and hypertension were significantly higher than those in the successful thrombolysis group;the differences were statistically significant(P<0.05).LVEF,GRACE score,NT proBNP,sFas,Caspasec-3,sTRAIL,hypertension tolerance of 0.320-0.520,and VIF of 1.900-3.115 showed a low likelihood of multicollinearity.The results of multiple logistic regression equation analysis showed that LVEF,NT-proBNP,sFas,Caspasec-3,GRACE score,sTRAIL,and hypertension were all factors affecting thrombolysis failure in AMI patients(P<0.05).In the validation and training sets,the failure rates of thrombolysis in high-risk patients were 21.43%and 30.00%,while those in low-risk patients were 11.43%and 5.00%,respectively.Pearson correlation coef

关 键 词：急性心肌梗死 溶栓 治疗结局 预警因素 危险分层系统 

分 类 号：R542.22[医药卫生—心血管疾病]