冠心病PCI术后主要不良心血管事件风险中西医结合临床预测模型建立  

Development of Integrated Chinese and Western Medicine Clinical Prediction Model for Risk of Major Adverse Cardiovascular Events after Percutaneous Coronary Intervention in Patients with Coronary Heart Disease

作　　者：陶诗怡 于林童 杨德爽 黄力[2] 吴佳芸 李军[4] 邵明晶[2] TAO Shi-yi;YU Lin-tong;YANG De-shuang;HUANG Li;WU Jia-yun;LI Jun;SHAO Ming-jing(Graduate School,Beijing University of Chinese Medicine,Beijing 100029;Department of Integrative Cardiology,China-Japan Friendship Hospital,Beijing 100029;Department of Cardiology,Shenzhen Hospital of Beijing University of Chinese Medicine(Longgang),Guangdong 518000;Department of Cardiology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053)

机构地区：[1]北京中医药大学研究生院,北京100029 [2]中日友好医院中西医结合心脏内科,北京100029 [3]北京中医药大学深圳医院(龙岗)心病科,广东518000 [4]中国中医科学院广安门医院心血管科,北京100053

出　　处：《中国中西医结合杂志》2025年第2期153-161,共9页Chinese Journal of Integrated Traditional and Western Medicine

摘　　要：目的 构建冠心病经皮冠状动脉介入术(PCI)后主要不良心血管事件(MACEs)风险中西医结合临床预测模型,为高风险患者的早期筛查和诊断提供借鉴。方法 纳入中日友好医院2019年9月-2022年3月冠心病PCI术后的连续病例1 137例,按5:1分为训练集(956例)和验证集(181例),利用Kaplan-Meier法进行生存分析,Lasso回归筛选影响因素,多因素Logistic回归建立冠心病PCI术后MACEs风险中西医结合临床预测模型。通过Hosmer-Lemeshow检验、校准曲线、受试者工作特征曲线(ROC)下面积(AUC)、净重新分类指数(NRI)和临床影响曲线(CIC)综合评估模型的临床预测效能。结果 生存分析显示两数据集中位生存时间分别为21.44、18.87个月(P=0.950)。Lasso-Logistic回归分析初步判断20个变量为PCI术后MACEs的影响因素,保护因素包括较高的血红蛋白(Hb)、左室射血分数(LVEF)、日常生活自理能力(ADL)水平,中西医结合治疗和阿司匹林用药史;危险因素包括女性,较高的年龄、心率、体重指数(BMI)、中性粒细胞淋巴细胞比值、血肌酐(SCr)、空腹血糖(FBG)、同型半胱氨酸(HCY)水平,陈旧性心肌梗死病史,心脑血管病家族史,植入支架数量及中医血瘀、气滞、痰浊、气虚证素,其中年龄、心率、BMI、FBG、HCY、LVEF、陈旧性心肌梗死病史、心脑血管病家族史、植入支架数量及中医血瘀、气滞、痰浊、气虚证素为独立影响因素(P<0.05)。Hosmer-Lemeshow检验(χ2=7.703,P=0.463)、校准曲线和ROC分析(AUC=0.908)提示模型的拟合度和区分度较好,且正确判断MACEs事件的综合能力提高了11.8%(NRI=0.118,95%CI:0.041~0.187,P=0.002);CIC结果表明当风险阈值60%,MACEs阳性估计值较接近实际人数。结论 本研究建立的冠心病PCI术后MACEs风险中西医结合临床预测模型具备较好的临床预测效能,有望协助预警高危人群,指导临床决策。Objective To establish an integrated Chinese and Western medicine clinical prediction model for the risk of major adverse cardiovascular events(MACEs) following percutaneous coronary intervention(PCI) in patients with coronary heart disease(CHD), and offer a reference for the early screening and diagnosis of high-risk patients. Methods A total of 1 137 patients of CHD after PCI from September 2019 to March 2022 in China-Japan Friendship Hospital were enrolled and assigned to the derivation set(956 cases) and validation set(181 cases) with a ratio of 5:1. Survival analysis was conducted by Kaplan-Meier method. The least absolute shrinkage and selection operator(Lasso) regression analysis was used to screen for predictors, and multivariate Logistic regression analysis was conducted to establish an integrated Chinese and Western medicine clinical prediction model for MACEs risk after PCI in patients with CHD. The Hosmer-Lemeshow test, calibration curve, area under curve(AUC) of receiver operating characteristic(ROC), net reclassification index(NRI), and clinical impact curve(CIC) were conducted to comprehensively evaluate the prediction ability of the model. Results Kaplan-Meier survival analysis suggested the median survival time of patients was 21.44months and 18.87 months(P=0.950), respectively. A total of 20 variables were preliminarily identified of MACEs risk after PCI through Lasso-Logistic regression analysis. Higher levels of hemoglobin(Hb), high left ventricular ejection fraction(LVEF) and high activity of daily living(ADL) score, combined treatment of Chinese and Western medicine, and history of aspirin medication were the protective factors;however, female, elevated age, heart rate(HR), body mass index(BMI), neutrophil-lymphocyte ratio(NLR), serum creatinine(SCr), fasting bloodglucose(FBG) and homocysteine(HCY), history of old myocardial infarction, family history of cardiovascular and cerebrovascular disease, the number of stents implanted, and Chinese medicine syndrome elements including blood stasis,

关 键 词：心血管疾病 冠状动脉粥样硬化性心脏病 经皮冠状动脉介入术 临床预测模型 主要不良心血管事件 中西医结合 

分 类 号：R541.4[医药卫生—心血管疾病]