基于心肌标志物预测老年STEMI并发心力衰竭的风险预测Nomogram模型的建立  

Establishment of a Nomogram model for risk prediction based on myocardial markers to predict complicated heart failure in elderly STEMI

作　　者：马梦涵 刘晓晓 MA Menghan;LIU Xiaoxiao(The First Affiliated Hospital of Henan University,Kaifeng,Henan 475001,China)

机构地区：[1]河南大学第一附属医院,河南开封475001

出　　处：《现代医药卫生》2024年第23期3985-3992,4000,共9页Journal of Modern Medicine & Health

基　　金：河南省开封市科技发展计划项目(2203021)。

摘　　要：目的探讨心肌标志物对老年ST段抬高型心肌梗死(STEMI)并发心力衰竭的风险预测价值,且基于此建立心力衰竭并发风险预测Nomogram模型。方法回顾性分析2020年5月至2023年5月该院收治的531例行经皮冠状动脉(冠脉)介入治疗(PCI)的老年STEMI患者的临床资料,按2∶1比例随机分为训练集(354例)和验证集(177例)。根据PCI后随访6个月心力衰竭并发情况将训练集患者分为并发心力衰竭组(82例)和未并发心力衰竭组(272例)。通过受试者工作特征(ROC)曲线评估心肌标志物对老年STEMI并发心力衰竭的预测价值,采用多因素logistic回归模型分析老年STEMI并发心力衰竭的危险因素。基于多因素分析结果建立风险预测Nomogram模型并对其进行验证。结果PCI后肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)、cTnI、肌红蛋白(MYO)检测预测老年STEMI并发心力衰竭的灵敏度分别为78.05%、76.83%、78.05%、75.61%,特异度分别为75.37%、79.04%、79.74%、75.74%,ROC曲线下面积分别为0.761、0.797、0.804、0.778;前壁梗死、多支血管病变、梗死面积、冠脉Gensini评分,以及PCI前中性粒细胞/淋巴细胞比值、血小板计数、血尿酸、氨基末端B型脑钠肽前体(NT-proBNP)及PCI后CK-MB、cTnT、cTnI、MYO、慢/无复流均为老年STEMI患者PCI后并发心力衰竭的危险因素(P<0.05);构建的老年STEMI并发心力衰竭的风险预测Nomogram模型训练集与验证集的一致性指数分别为0.854、0.833,校正曲线与理想曲线贴合较好;训练集灵敏度、特异度、ROC曲线下面积分别为85.71%、83.85%、0.874,验证集分别为82.86%、81.54%、0.858;当训练集阈值概率为0~0.85、验证集为0~0.90时Nomogram模型预测老年STEMI并发心力衰竭风险可获得较高的净收益。结论PCI后检测CK-MB、cTnT、cTnI、MYO均对老年STEMI患者PCI后并发心力衰竭具有一定的预测价值,此4项指标与前壁梗死、多支血管病变、梗死面积、冠脉GensiniObjective To investigate the predictive value of myocardial markers for the risk of heart failure complicating ST-segment elevation myocardial infarction(STEMI)in the elderly and to develop a Nomogram model for the prediction of the risk of heart failure complicating STEMI.Methods A retrospective analysis of the clinical data of 531 elderly STEMI patients who underwent percutaneous coronary artery(coronary)intervention(PCI)admitted to the hospital from May 2020 to May 2023 was performed,and they were randomly divided into a training set(354 patients)and a validation set(177 patients)in a 2∶1 ratio.Patients in the training set were categorized into a concomitant heart failure group(82 cases)and an uncomplicated heart failure group(272 cases)according to the complication of heart failure at 6-month follow-up after PCI.The predictive value of myocardial markers for heart failure complicated by STEMI in the elderly was assessed by receiver operating characteristic(ROC)curves,and the risk factors for heart failure complicated by STEMI in the elderly were analyzed by multifactorial logistic regression model.A risk prediction Nomogram model was established and validated based on the results of the multifactorial analysis.Results The sensitivity of post-PCI creatine kinase isoenzyme(CK-MB),troponin T(cTnT),cTnI,and myoglobin(MYO)assays for predicting STEMI-complicated heart failure in the elderly was 78.05%,76.83%,78.05%,and 75.61%,respectively,and the specificity was 75.37%,79.04%,79.74%,75.74%,respectively,area under the ROC curve was 0.761,0.797,0.804,0.778;anterior wall infarction,multibranch vasculopathy,infarct area,coronary Gensini score,and pre-PCI neutrophil/lymphocyte ratio,platelet count,blood uric acid,amino-terminal B-type brain natriuretic peptide precursor(NT-proBNP)and post-PCI CK-MB,cTnT,cTnI,MYO,and slow/no reentry were all risk factors for concomitant heart failure after PCI in elderly STEMI patients(P<0.05).The consistency indices of the constructed Nomogram model for risk prediction of complicated

关 键 词：ST段抬高型心肌梗死 老年人 心肌标志物 心力衰竭 Nomogram模型 预测 

分 类 号：R542.22[医药卫生—心血管疾病] R541.61[医药卫生—内科学]