新疆塔城地区冠心病患者冠脉多支病变发病风险列线图预测模型的构建  

Construction of the nomogram prediction model for the risk of coronary multivessel disease in patients with coronary heart disease in Tacheng area,Xinjiang

作　　者：徐以康 杨洋[1] 马晶茹[1] 刘蕾 张志峰 孙斯琪 李曼曼 占凯雯 马军 XU Yi-kang;YANG Yang;MA Jing-ru;LIU Lei;ZHANG Zhi-feng;SUN Si-qi;LI Man-man;ZHANG Kai-wen;MA Jun(Department of Cardiology,the Second Affiliated Hospital of Shenyang Medical College,Shenyang 110001,Liaoning,CHINA;School of Nursing,Liaoning University of Traditional Chinese Medicine,Shenyang 110033,Liaoning,CHINA;Department of Cardiology,Tacheng People's Hospital,Tacheng 834700,Xinjiang,CHINA)

机构地区：[1]沈阳医学院附属第二医院心内科,辽宁沈阳110001 [2]辽宁中医药大学护理学院,辽宁沈阳110033 [3]塔城市人民医院心内科,新疆塔城834700

出　　处：《海南医学》2024年第19期2743-2748,共6页Hainan Medical Journal

基　　金：辽宁省自然科学基金科技援疆、援藏医疗专项项目(编号:2023-MS-19);2022年度辽宁省沈阳市科学技术计划项目(编号:2-321-33-100)。

摘　　要：目的分析新疆塔城地区冠心病患者冠脉多支病变的危险因素,并构建冠脉多支病变发病风险的列线图预测模型。方法通过查阅患者电子病历,回顾性收集并分析2021年1月至2023年6月期间在塔城市人民医院心内科住院治疗的348例冠心病患者的临床资料,所有患者均接受选择性冠脉造影术,其中单支病变167例,多支病变181例。使用随机数表法将348例患者按7∶3的比例分为训练组(n=243)和验证组(n=105),训练组数据用于模型构建,验证组数据用于模型验证。比较两组患者的临床资料,基于赤池信息准则(AIC),单因素和多因素Logistic双向逐步回归法筛选出关键模型变量,构建塔城地区冠脉多支病变发病风险的列线图预测模型。利用受试者工作特征(ROC)曲线下面积(AUC)、校准曲线和临床决策曲线(DCA)综合评估模型的区分度、校准度和临床实用性。结果训练组中,经单因素和多因素Logistic双向逐步回归法分析结果显示,年龄、吸烟、陈旧心肌梗死是冠脉多支病变的危险因素(P<0.05),而无糖尿病是冠脉多支病变的保护因素(P<0.05);基于上述关键因子构建并绘制MVD风险列线图预测模型;ROC曲线分析结果显示,训练组和验证组的AUC分别为0.720(95%CI:0.656~0.783)和0.707(95%CI:0.586~0.789),两组校准曲线与理想曲线拟合度均良好,预测值与实际值相契合,两组临床决策曲线结果均提示本模型具备临床净获益。结论本研究构建的新疆塔城地区冠心病患者冠脉多支病变发病风险预测模型预测性能良好,可为本地区快速识别冠脉多支病变高风险人群提供高效工具。Objective To analyze the risk factors of coronary multivessel disease in patients with coronary heart disease in Tacheng Prefecture,Xinjiang,and construct the nomogram prediction model for the risk of coronary multivessel disease.Methods The clinical data of 348 patients with coronary heart disease hospitalized in the Department of Cardiology,Tacheng People's Hospital between January 2021 and June 2023 were retrospectively collected and analyzed by reviewing the patients'electronic medical records.All the patients included in the study underwent selective coronary angiography,and they were classified into single vessel disease(n=167)and multivessel disease(n=181)according to the results of the coronary angiography.The patients were also divided into training group(n=243)and validation group(n=105)in the ratio of 7∶3.The data of the training group were used for model construction,and the data of the validation group were used for model validation.The clinical data of patients in the two groups were compared,and based on the Akaike Information Criteria(AIC),the key model variables were screened out by single-factor and multiple-factor logistic regression to construct the nomogram prediction model for the risk of coronary multivessel disease in Tacheng area.The discrimination,calibration,and clinical practicality of the mode were comprehensively evaluated using the area under the receiver operating characteristic(ROC)curve(AUC),calibration curve,and clinical decision curve analysis(DCA).Results In the training group,age,smoking,and old myocardial infarction were risk factors for coronary multivessel disease(P<0.05),and non-diabetes was a protective factor for coronary multivessel disease(P<0.05).ROC curve showed that the AUC in the training group and validation group were 0.720(95%CI:0.656-0.783)and 0.707(95%CI:0.586-0.789),respectively.The calibration curves of both groups were well fitted to the ideal curve,and the predicted values were consistent with the actual values.The clinical DCA of both groups indicated

关 键 词：新疆塔城地区 冠心病 冠脉多支病变 列线图 风险预测 

分 类 号：R541.4[医药卫生—心血管疾病]