冠心病PCI患者围术期焦虑抑郁风险的列线图预测模型构建  

Construction of a nomogram prediction model for perioperative anxiety and depression risk in PCI patients with coronary heart disease

作　　者：郝明璐 杜瑶 马玉娇 王骋[1] HAO Minglu;DU Yao;MA Yujiao(Jiangsu Provincial People’s Hospital(The First Affiliated Hospital of Nanjing Medical University),Nanjing 210029,China)

机构地区：[1]江苏省人民医院(南京医科大学第一附属医院),江苏南京210029

出　　处：《精神医学杂志》2024年第3期225-229,共5页Journal of Psychiatry

基　　金：国家自然科学基金青年科学基金项目(编号:82100338)。

摘　　要：目的探讨冠心病经皮冠状动脉介入治疗(PCI)患者围术期焦虑抑郁的影响因素。方法选取255例冠心病患者作为研究对象,所有患者均完成PCI,使用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估患者的焦虑抑郁情况,基于评价结果将其分为焦虑抑郁组(96例)及非焦虑抑郁组(159例),采用多因素Logistic回归分析冠心病PCI患者围术期的焦虑抑郁的独立影响因素。利用R软件构建冠心病PCI患者围术期焦虑抑郁发生风险的列线图预测模型,采用受试者工作特征曲线(ROC)及霍斯默-莱梅肖(H-L)拟合优度检验列线图模型的预测效能。结果两组性别、家庭平均月收入、支架数量、缴费方式以及领悟社会支持量表(PSSS)评分比较差异均有统计学意义(P<0.05)。回归分析结果显示,性别为女性、家庭平均月收入≤3000元、支架数量≥2个、缴费方式为医保、PSSS评分较低是影响冠心病PCI患者围术期焦虑抑郁的独立影响因素(P<0.05)。构建预测模型,ROC曲线下面积(AUC)为0.76,敏感度为84.9%,特异度为53.1%,H-L检验χ^(2)=8.349,P=0.400。结论女性、家庭平均收入较低、支架数量≥2、缴费方式自费、社会支持较低是冠心病PCI患者围术期中容易出现焦虑抑郁情绪的影响因素,基于上述因素构建的列线图风险预测模型预测效能较好,有助于患者的治疗及康复。Objective To explore the influencing factors of perioperative anxiety and depression in patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods A total of 255 patients diagnosed with coronary heart disease having completed PCI were included as study objects and assessed with Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS).Based on the evaluation results,the patients were divided into anxiety and depression group(96 cases)and non-anxiety and depression group(159 cases).Multivariate logistic regression was used to analyze the independent influencing factors of anxiety and depression in perioperative period of PCI patients.R software was used to construct a nomogram prediction model of perioperative anxiety and depression risk in PCI patients with coronary heart disease.Receiver operating characteristic(ROC)curve and Hosmer-Lemeshaw(H-L)goodness of fit were used to test the prediction efficiency of the nomogram model.Results Through univariate analysis,gender,average family monthly income,number of stents,payment method and Perceived Social Support Scale(PSSS)score were the influencing factors of anxiety and depression(P<0.05).Multivariate logistic regression analysis showed that female,the average family monthly income≤3000,the number of stents≥2,medical insurance as payment method and low PSSS score were independent influencing factors for perioperative anxiety and depression in patients with PCI(P<0.05).The area under ROC curve(AUC)was 0.76,with sensitivity as 84.9%,and specificity as 53.1%.H-L test showedχ^(2)=8.349,P=0.400.Conclusion Female,low average family income,number of stents≥2,self-payment method,and low social support are the influencing factors of perioperative anxiety and depression in patients with coronary heart disease after PCI.The risk prediction model built on the basis of the above factors has better prediction efficiency and contributes to the treatment and rehabilitation of patients.

关 键 词：冠心病 PCI 围术期 焦虑抑郁 影响因素 列线图 预测模型 

分 类 号：R541.4[医药卫生—心血管疾病] R749.4[医药卫生—内科学]