心肌梗死患者PCI后发生心肌内出血的影响因素分析及其风险预测列线图模型构建与验证  

Influencing Factors of Intramyocardial Hemorrhage in Patients with Myocardial Infarction after PCI and Construction and Validation of Its Risk Prediction Nomogram Model

作　　者：酉鹏华 梁健 韩稳琦 YOU Penghua;LIANG Jian;HAN Wenqi(Cardiovascular Medicine,Shaanxi Provincial People's Hospital,Xi'an 710061,China)

机构地区：[1]陕西省人民医院心血管内科,陕西省西安市710061

出　　处：《实用心脑肺血管病杂志》2024年第7期10-15,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：陕西省自然科学基础研究计划项目(2022JM-540)。

摘　　要：目的 分析心肌梗死患者PCI后发生心肌内出血(IMH)的影响因素,并构建及验证其风险预测列线图模型。方法 选取2022年1月—2023年5月就诊于陕西省人民医院并接受PCI的心肌梗死患者186例为建模组,另选取同期就诊于陕西省人民医院并接受PCI的心肌梗死患者94例为验证组。根据PCI后IMH发生情况,将建模组患者分为IMH亚组(n=58)及非IMH亚组(n=128)。收集患者的临床资料,采用多因素Logistic回归分析探讨心肌梗死患者PCI后发生IMH的影响因素;基于多因素Logistic回归分析结果构建心肌梗死患者PCI后发生IMH的风险预测列线图模型;对该列线图模型进行内部验证(采用Bootstrap法自抽样1 000次以评估该列线图模型的一致性,采用Hosmer-Lemeshow检验及校准曲线评估该列线图模型的校准度,采用决策曲线评估该列线图模型的临床适用性)和外部验证(采用ROC曲线评估该列线图模型的区分度)。结果 多因素Logistic回归分析结果显示,梗死部位、闭塞冠状动脉开通时间、病变血管支数、血红蛋白、使用血小板糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂是心肌梗死患者PCI后发生IMH的影响因素(P<0.05)。基于多因素Logistic回归分析结果构建心肌梗死患者PCI后发生IMH的风险预测列线图模型。采用Bootstrap法自抽样1 000次,结果显示,建模组中该列线图模型的一致性指数(CI)为0.818。Hosmer-Lemeshow检验及校准曲线分析结果显示,该列线图模型在建模组中的拟合程度较好(χ^(2)=6.933,P=0.544)。决策曲线分析结果显示,在建模组中当阈值概率>0.14时,该列线图模型的临床净获益>0。ROC曲线分析结果显示,该列线图模型预测验证组心肌梗死患者PCI后发生IMH的AUC为0.918〔95%CI(0.868~0.953)〕。结论 梗死部位、闭塞冠状动脉开通时间、病变血管支数、血红蛋白、使用GP Ⅱb/Ⅲa受体拮抗剂是心肌梗死患者PCI后发生IMH的影响因素,本研究基于上述影�Objective To analyze the influencing factors of intramyocardial hemorrhage(IMH)in patients with myocardial infarction after PCI,construct and verify its risk prediction nomogram model.Methods A total of 186 patients with myocardial infarction who received PCI in Shaanxi Provincial People's Hospital from January 2022 to May 2023 were selected as the modeling group,and 94 patients with myocardial infarction who received PCI in Shaanxi Provincial People's Hospital during the same period were selected as the test model group.According to the occurrence of IMH after PCI,patients in the modeling group were divided into IMH subgroup(n=58)and non-IMH subgroup(n=128).The clinical data of patients were collected,and the influencing factors of IMH in patients with myocardial infarction after PCI were investigated by multivariate Logistic regression analysis.Based on the results of multivariate Logistic regression analysis,the risk prediction nomogram model of IMH in patients with myocardial infarction after PCI was constructed.The nomogram model was validated internally(Bootstrap method was used to self-sample 1000 times to evaluate the consistency of the nomogram model,Hosmer-Lemeshow test and calibration curves were used to evaluate the calibration degree of the nomogram model,and decision curve was used to evaluate the clinical applicability of the nomogram model)and externally(ROC curve was used to evaluate the differentiation of the nomogram model).Results Multivariate Logistic regression analysis showed that infarct location,opening time of occlusive coronary artery,number of diseased vessels,hemoglobin,and use of platelet glycoprotein(GP)Ⅱb/Ⅲa receptor antagonists were the influencing factors of IMH in patients with myocardial infarction after PCI(P<0.05).Based on the results of multivariate Logistic regression analysis,the risk prediction nomogram model of IMH in patients with myocardial infarction after PCI was constructed.Bootstrap method self-sampled 1000 times,and the results showed that the consistency inde

关 键 词：心肌梗死 经皮冠状动脉介入治疗 心肌内出血 影响因素分析 列线图 

分 类 号：R542.22[医药卫生—心血管疾病]