老年急性心肌梗死患者经皮冠状动脉介入术后心力衰竭预测模型的构建  

Establishment of a prediction model for heart failure after percutaneous coronary intervention in elderly patients with acute myocardial infarction

作　　者：刘晶晶[1] 刘浩[1] 于秀平 LIU Jingjing;LIU Hao;YU Xiuping(Intensive Care Unit,the First Hospital Affiliated to Harbin Medical University,Harbin,Heilongjiang,150007;Department of Acupuncture and Moxibustion,the First Hospital Affiliated to Heilongjiang University of Traditional Chinese Medicine,Harbin,Heilongjiang,150040)

机构地区：[1]哈尔滨医科大学附属第一医院重症医学科,黑龙江哈尔滨150007 [2]黑龙江中医药大学附属第一医院针灸科,黑龙江哈尔滨150040

出　　处：《实用临床医药杂志》2024年第15期84-89,共6页Journal of Clinical Medicine in Practice

基　　金：黑龙江省卫生健康委科研课题(2020-106)。

摘　　要：目的建立老年急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)后并发心力衰竭(HF)的预测模型。方法回顾性纳入2019年1月—2022年12月哈尔滨医科大学附属第一医院收治的326例老年AMI患者,依据术后6个月时HF发生情况将其分为AMI-HF组89例和非AMI-HF组237例。通过电子病历系统收集所有患者的临床资料,采用多因素Logistic回归分析法筛选AMI并发HF的危险因素,并构建预测模型;采用受试者工作特征(ROC)曲线评价预测模型的性能。结果单因素分析显示,与非AMI-HF组比较,AMI-HF组年龄>75岁、糖尿病患者比率以及Gensini评分、心肌肌钙蛋白I(cTnI)、N末端B型钠尿肽前体(NT-proBNP)、血尿酸、超敏C反应蛋白(hs-CRP)水平均较高,左心室射血分数(LVEF)、心肌梗死溶栓试验(TIMI)血流3级比率较低,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、Gensini评分、NT-proBNP、hs-CRP是老年AMI患者PCI后发生HF的独立危险因素(P<0.05),TIMI分级是其保护因素(P<0.05)。基于筛选的危险因素计算出C-Index后,采用ROC曲线评估C-Index对HF的预测能力,结果显示AUC为0.878(95%CI:0.834~0.921),灵敏度为86.52%,特异度为75.95%,准确率为78.83%。结论年龄、Gensini评分、NT-proBNP、hs-CRP是老年AMI患者PCI后发生HF的独立危险因素,TIMI分级是其保护因素,据此构建的模型可预测HF发生风险,从而辅助临床早期识别HF高危人群,并进行个体化干预。Objective To establish a prediction model for heart failure(HF)after percutaneous coronary intervention(PCI)in elderly patients with acute myocardial infarction(AMI).Methods A total of 326 elderly AMI patients in the First Hospital Affiliated to Harbin Medical University from January 2019 to December 2022 were retrospectively enrolled and divided into AMI-HF group(n=89)and non-AMI-HF group(n=237)based on the occurrence of HF at 6 months after surgery.Clinical materials of all the patients were collected through the electronic medical record system.Multivariate Logistic regression analysis was used to screen the risk factors of AMI complicated with HF and to construct a prediction model.The performance of the prediction model was evaluated by the receiver operating characteristic(ROC)curve.Results Univariate analysis showed that compared with the non-AMI-HF group,the AMI-HF group had higher proportions of patients aged over 75 years,diabetics,and higher levels of Gensini score,cardiac troponin I(cTnI),N-terminal pro-brain natriuretic peptide(NT-proBNP),blood uric acid,and high-sensitivity C-reactive protein(hs-CRP),while the left ventricular ejection fraction(LVEF)and the proportion of grade 3 of Thrombolysis in Myocardial Infarction(TIMI)blood flow were lower in the AMI-HF group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis revealed that age,Gensini score,NT-proBNP,and hs-CRP were independent risk factors for HF after PCI in elderly AMI patients(P<0.05),while TIMI grade was a protective factor(P<0.05).After calculating the C-Index based on the screened risk factors,the ROC curve was used to evaluate the predictive ability of the C-Index for HF,showing an area under the curve(AUC)of 0.878(95%CI,0.834 to 0.921),with a sensitivity of 86.52%,a specificity of 75.95%,and an accuracy of 78.83%.Conclusion Age,Gensini score,NT-proBNP and hs-CRP are independent risk factors for HF after PCI in elderly AMI patients,while TIMI grade is a protective factor.The model const

关 键 词：急性心肌梗死 经皮冠状动脉介入术 心力衰竭 老年人群 N末端B型钠尿肽前体 预测模型 

分 类 号：R542.2[医药卫生—心血管疾病] R319[医药卫生—内科学] R615[医药卫生—临床医学]