冠脉介入后心绞痛患者心力衰竭的Nomogram风险模型构建及重要性矩阵分析  

Construction of Nomogram risk model and importance matrix analysis of heart failure in patients with angina pectoris after coronary intervention

作　　者：石云霄 王卫国 程常福 李佳 SHI Yun-xiao;WANG Wei-guo;CHENG Chang-fu;LI Jia(Department of Cardiology,Kaifeng Traditional Chinese Medicine Hospital,Kaifeng 475000,Henan,CHINA;Department of Cardiovascular Medicine,Kaifeng People's Hospital,Kaifeng 475000,Henan,CHINA)

机构地区：[1]开封市中医院心病科,河南开封475000 [2]开封市人民医院心血管内科,河南开封475000

出　　处：《海南医学》2024年第16期2288-2294,共7页Hainan Medical Journal

基　　金：河南省开封市科技攻关计划项目(编号:2003105)。

摘　　要：目的探讨冠脉介入后心绞痛患者心力衰竭(HF)的影响因素,并构建Nomogram风险模型及重要性矩阵。方法前瞻性选取2017年8月至2023年8月于开封市中医院行冠脉介入后的568例心绞痛患者作为研究对象,按照冠脉介入后6个月是否并发HF分为发生组92例和未发生组476例。比较两组患者的临床资料,采用Logistic回归模型分析冠脉介入后心绞痛患者HF的影响因素,构建Nomogram预测模型,采用受试者工作特征(ROC)曲线、决策曲线、校正曲线验证Nomogram预测模型预测价值和临床效用,并进一步进行重要性矩阵分析。结果发生组患者合并高血压、单支病变血管数例数占比分别为61.96%、26.09%,明显高于未发生组的37.61%、13.87%,发病至手术时间为(9.21±2.41)h,明显长于未发生组的(6.75±1.87)h,差异均有统计学意义(P<0.05);发生组患者术后心肌梗死溶栓试验(TIMI)血流分级0~1级、2级例数占比分别为4.35%、18.48%,明显高于未发生组的1.05%、9.03%,差异均有统计学意义(P<0.05);发生组患者的醛固酮(Ald)、B型脑利钠肽(BNP)、C1q肿瘤坏死因子相关蛋白1(CTRP1)、内脏脂肪素(Visfatin)、氧化低密度脂蛋白(ox-LDL)水平分别为(214.67±34.19)μg/L、(2143.65±234.15)pg/mL、(12.88±2.67)ng/mL、(15.26±3.66)ng/mL、(52.39±7.85)U/L,明显高于未发生组的(179.52±25.39)μg/L、(786.34±187.96)pg/mL、(9.52±2.14)ng/mL、(12.39±2.74)ng/mL、(45.79±6.47)U/L,差异均有统计学意义(P<0.05);发生组患者的血红蛋白(Hb)、淋巴细胞计数(LC)水平分别为(5.88±1.06)g/L、(1.42±0.36)×10^(9)/L,明显低于未发生组的(9.76±2.28)g/L、(1.75±0.41)×10^(9)/L,差异均有统计学意义(P<0.05);发生组患者的自我管理能力评分为(72.36±20.17)分,明显低于未发生组的(105.47±23.74)分,差异有统计学意义(P<0.05);Logistic回归模型分析结果提示,合并高血压、发病至手术时间、BNP、CTRP1、Visfatin、Ox-LDL均是冠脉介入后心绞痛患�Objective To explore the influencing factors of heart failure(HF)in patients with angina pectoris after coronary intervention,and construct a Nomogram risk model and importance matrix.Methods A prospective study was conducted on 568 patients with angina pectoris who underwent coronary intervention at Kaifeng Traditional Chinese Medicine Hospital from August 2017 to August 2023.These patients were divided into a group of 92 cases with HF complications and a group of 476 cases without HF complications,based on whether they developed HF complications within six months after coronary intervention.The clinical data of the two groups were compared,and the logistic regression model was used to analyze the influencing factors of HF in patients with angina pectoris after coronary intervention.The Nomogram prediction model was constructed,and the receiver operating characteristic(ROC)curve,decision gram prediction model.Furthermore,an importance matrix analysis was conducted.Results The proportions of patients with hypertension and single-vessel lesions in the group with complications were 61.96%and 26.09%,respectively,which were significantly higher than 37.61%and 13.87%in the group without complications(P<0.05).The time from onset to surgery was(9.21±2.41)hours,which was significantly longer than(6.75±1.87)hours in the group without complications(P<0.05).The proportions of patients with postoperative thrombolysis in myocardial infarction(TIMI)flow grade 0-1 and grade 2 in the group with complications were 4.35%and 18.48%,respectively,which were significantly higher than 1.05%and 9.03%in the group without complications(P<0.05).The levels of aldosterone(Ald),B-type natriuretic peptide(BNP),C1q tumor necrosis factor-related protein 1(CTRP1),visfatin,and oxidized low-density lipoprotein(ox-LDL)in the group with complications were(214.67±34.19)μg/L,(2143.65±234.15)pg/mL,(12.88±2.67)ng/mL,(15.26±3.66)ng/mL,and(52.39±7.85)U/L,respectively,which were significantly higher than(179.52±25.39)μg/L,(786.34±187.96)pg/mL,(9.

关 键 词：冠脉介入 心绞痛 心力衰竭 Nomogram风险模型 重要性矩阵 危险因素 保护因素 

分 类 号：R541[医药卫生—心血管疾病]