急性心肌梗死患者心源性休克发生风险预测模型的构建与验证  

Construction and validation of a risk prediction model for cardiogenic shock in patients with acute myocardial infarction

作　　者：李春景 皇甫士懿 郭宏[1] 李尤 徐以康 曲志鑫 赵轩 LI Chunjing;HUANGFU Shiyi;GUO Hong;LI You;XU Yikang;QU Zhixin;ZHAO Xuan(School of Nursing,Shenyang Medical College,Liaoning Province,Shenyang110001,China;Department of Nursing,Jinqiu Hospital,Liaoning Province,Shenyang110001,China;Department of Cardiology,the Second Affiliated Hospital of Shenyang Medical College,Liaoning Province,Shenyang110001,China;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of China Medical University,Liaoning Province,Shenyang110001,China;Department of Psychology,Shenyang Mental Health Center,Liaoning Province,Shenyang110001,China)

机构地区：[1]沈阳医学院护理学院,辽宁沈阳110001 [2]辽宁省金秋医院护理部,辽宁沈阳110001 [3]沈阳医学院附属第二医院心内科,辽宁沈阳110001 [4]中国医科大附属第一医院呼吸与危重症医学科,辽宁沈阳110001 [5]沈阳市精神卫生中心心理科,辽宁沈阳110001

出　　处：《中国当代医药》2024年第33期20-25,共6页China Modern Medicine

基　　金：沈阳医学院大学生科研课题辽宁省级立项项目(S202210164005)。

摘　　要：目的分析急性心肌梗死(AMI)发生心源性休克(CS)的影响因素并建立预测模型。方法选取2022年6月至2024年6月沈阳医学院附属第二医院收治的292例AMI患者为研究对象,收集临床资料,采用单因素和多因素logistic回归分析患者发生CS的风险因素并构建预测模型,采用ROC曲线分析AMI患者发生CS风险预测模型的预测价值。结果48例AMI患者发生CS,院内发生率为16.4%。单因素分析结果显示,室颤/室速、脑卒中史、N末端B型利钠肽原(NT-proBNP)、尿素氮(BUN)、血肌酐(Scr)、乳酸脱氢酶(LDH)、左心室射血分数(LVEF)、左室舒张末期内径(LVDD)、乳酸(LAC)、血红蛋白(Hb)、空腹血糖(FPG)、C-反应蛋白(CRP)、心肌肌钙蛋白Ⅰ峰值(cTnⅠ)、红细胞绝对值(RBC)、白细胞绝对值(WBC)、糖化血红蛋白(HbA1c)、肌红蛋白(MYO)、游离三碘甲状腺原氨酸(FT3)与AMI患者发生CS有关,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,Scr(β=0.007,OR=1.007,95%CI:1.005~1.010)、RBC(β=0.031,OR=1.956,95%CI:1.271~2.125)、BUN(β=0.059,OR=1.061,95%CI:1.026~1.097)、NT-proBNP(β=0.132,OR=1.236,95%CI:1.012~1.968)、LAC(β=0.08,OR=1.084,95%CI:1.018~1.154)是急性心肌梗死患者发生心源性休克的独立危险因素(P<0.05);LVEF(β=-0.019,OR=0.981,95%CI:0.964~0.998)是急性心肌梗死患者发生心源性休克的独立保护因素(P<0.05)。该预测模型预测AMI患者发生CS风险的曲线下面积为0.755。结论基于Scr、RBC、BUN、NT-proBNP、LVEF、LAC构建的AMI患者并发CS发生风险预测模型价值较高,可指导临床医务人员的筛查。Objective The influencing factors of cardiogenic shock(CS)in acute myocardial infarction(AMI)were analyzed and the predictive model was established.Methods A total of 292 patients with AMI admitted to the Second Affiliated Hospital of Shenyang Medical College from June 2022 to June 2024 were selected as the study objects,and clinical data were collected.Univariate and multivariate logistic regression were used to analyze the risk factors of CS occurrence in patients and construct prediction models.ROC curve was used to analyze the predictive value of CS risk prediction model in AMI patients.Results CS occurred in 48 patients with AMI,the hospital incidence was 16.4%.The results of single factor analysis showed that ventricular fibrillation/tachycardia,stroke history,N-terminal B-type natriuretic peptide(NT-proBNP),urea nitrogen(BUN),serum creatinine(Scr),lactate dehydrogenase(LDH),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVDD),lactic acid(LAC),hemoglobin(Hb),fasting blood glucose(FPG),C-reverse CRP,peak value of cardiac troponinⅠ(cTnⅠ),absolute value of red blood cells(RBC),absolute value of white blood cells (WBC), glycosylated hemoglobin (HbA1c), myoglobin (MYO) and free triiodothyronine (FT3) were associated with CS in AMI patients, the differences were statistically significant (P<0.05). Multivariate logistic regression analysis showed that Scr (β=0.007, OR=1.007, 95%CI: 1.005-1.010), RBC (β=0.031, OR=1.956, 95%CI: 1.271-2.125), BUN (β=0.059, OR=1.061, 95%CI: 1.026-1.097), and T-proBNP (β=0.132, OR=1.236, 95%CI: 1.012-1.968), LAC (β=0.08, OR=1.084, 95%CI: 1.018-1.154) were independent risk factors for CS in patients with AMI (P<0.05). And LVEF (β=-0.019, OR=0.981, 95%CI: 0.964-0.998) was independent protective factor for CS in patients with AMI (P<0.05). The area under the curve for predicting CS risk in AMI patients was 0.755. Conclusion The risk prediction model of AMI patients with CS based on Scr, RBC, BUN, NT-proBNP, LVEF and LAC has high value and can gu

关 键 词：急性心肌梗死 心源性休克 危险因素 预测价值 

分 类 号：R541[医药卫生—心血管疾病]