经皮冠状动脉介入术后支架内再狭窄风险预警模型建立及验证分析  

Development and validation of a risk prediction model for in-stent restenosis after percutaneous coronary intervention

作　　者：黄杰[1] 邹奇霖 赵俊球 丁路遥 Huang Jie;Zou Qilin;Zhao Junqiu;Ding Luyao(Department of Cardiology,Lishui Central Hospital,Lishui323000,Zhejiang Province,China)

机构地区：[1]丽水市中心医院心内科,丽水323000

出　　处：《中国基层医药》2025年第1期53-59,共7页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省丽水市科技计划(2020SJZC062)。

摘　　要：目的建立经皮冠状动脉介入术(PCI)后支架内再狭窄(ISR)风险预警模型,并进行验证分析。方法前瞻性选取2021年5月至2023年4月丽水市中心医院收治的行PCI治疗的急性心肌梗死(AMI)患者126例为研究对象,以术后是否发生ISR将其分为发生ISR组(33例)与未发生ISR组(93例)。分析比较两组基本临床资料,用二元logistic回归分析AMI患者建立PCI后发生ISR的独立危险因素,构建风险预警模型,并用受试者工作特征(ROC)曲线模型预测价值。结果发生ISR组与未发生ISR组术后吸烟、尿酸、血清淀粉样蛋白A(SAA)、脂蛋白(a)[Lp(a)]比较差异均有统计学意义,分别是术后有吸烟[21(63.64%)比27(29.03%)],尿酸偏高[19(57.58%)比28(30.11%)],SAA≥10 mg/L[20(60.61%)比26(27.96%)],Lp(a)≥300 mg/L[21(63.64%)比32(34.41%)],χ^(2)=12.36、7.85、11.20、8.53,均P<0.05)。术后吸烟、尿酸偏高、SAA≥10 mg/L、Lp(a)≥300 mg/L均是AMI患者建立PCI后发生ISR的独立危险因素(OR=0.234、0.317、0.252、0.300,均P<0.05)。基于术后吸烟、尿酸、SAA、Lp(a)建立PCI后ISR的风险预警模型,并进行ROC分析,其曲线下面积(AUC)分别为0.673[95%CI(0.564,0.782)]、0.637[95%CI(0.525,0.750)]、0.663[95%CI(0.552,0.774)]、0.646[95%CI(0.536,0.757)]、0.889[95%CI(0.821,0.958)]。取临界值时,灵敏度分别为0.636、0.576、0.606、0.636、0.909,特异度分别为0.710、0.699、0.720、0.656、0.763。用自助法(B=1000)对风险预警模型进行内部验证,修正偏差后的预测曲线趋于理想曲线,一致性指数为0.778,模型预测价值较高。风险预警模型在阈值概率范围0.02~0.93表现出净收益率>0的特点,超过了两条无效线。结论术后吸烟、尿酸、SAA、Lp(a)均是AMI患者建立PCI后发生ISR的独立危险因素,基于这4项因素构建的风险预警模型的预测价值较高,有助于评估AMI患者建立PCI后发生ISR的风险并为其制定相应的干预措施。ObjectiveTo develop and validate a risk prediction model for in-stent restenosis(ISR)after percutaneous coronary intervention(PCI).MethodsThis prospective study included 126 patients with acute myocardial infarction(AMI)who underwent PCI at Lishui Central Hospital from May 2021 to April 2023.The patients were divided into two groups based on whether they experienced ISR after PCI:ISR group(n=33)and non-ISR group(n=93).Clinical data were compared between the two groups.Binary logistic regression was used to identify independent risk factors for ISR in patients with AMI after PCI.A risk prediction model was then developed,and the predictive value of the model was assessed using receiver operating characteristic curve analysis.ResultsAfter surgery,significant differences were observed between the ISR and non-ISR groups regarding postoperative smoking[21(63.64%)vs.27(29.03%)],elevated uric acid level[19(57.58%)vs.28(30.11%)],serum amyloid A(SAA)≥10 mg/L[20(60.61%)vs.26(27.96%)],and lipoprotein(a)[Lp(a)]≥300 mg/L[21(63.64%)vs.32(34.41%)][χ^(2)=12.36,7.85,11.20,8.53,all P<0.05].Postoperative smoking,elevated uric acid levels,SAA≥10 mg/L,and Lp(a)≥300 mg/L were identified as independent risk factors for ISR in patients with AMI after PCI(OR=0.234,0.317,0.252,0.300,all P<0.05).A risk prediction model for ISR after PCI was developed based on postoperative smoking,elevated uric acid levels,SAA levels,and Lp(a)levels≥300 mg/L.Receiver operating characteristic curve analysis revealed the areas under the curve were 0.673[95%CI(0.564,0.782)],0.637[95%CI(0.525,0.750)],0.663[95%CI(0.552,0.774)],0.646[95%CI(0.536,0.757)],and 0.889[95%CI(0.821,0.958)]for ostoperative smoking,elevated uric acid levels,SAA levels,Lp(a)levels≥300 mg/L,and the risk prediction model,respectively.At the critical threshold values,the sensitivities for these variables were 0.636,0.576,0.606,0.636,and 0.909,respectively,while the specificities were 0.710,0.699,0.720,0.656,and 0.763,respectively.The bootstrap method(B=1000)was used for the inte

关 键 词：冠状动脉再狭窄 经皮冠状动脉介入治疗 心肌梗死 比例危险度模型 吸烟 尿酸 血清淀粉样蛋白A 脂蛋白(A) 

分 类 号：R54[医药卫生—心血管疾病]