列线图分析急性ST段抬高型心肌梗死PCI术后心肌缺血再灌注损伤的风险模型  

Risk model of myocardial ischemia-reperfusion injury after PCI for acute ST-segment elevation myocardial infarction was analyzed with the histogram

作　　者：汪文月 刘海莉[2] 唐冉冉 白召 翟春娟[3] 杨文静[1] WANG Wenyue;LIU Haili;TANG Ranran;BAI Zhao;ZHAI Chunjuan;YANG Wenjing(Intensive Care Unit,Hebei Port Group Co.,Ltd.Qinhuangdao Hospital of Integrated Traditional Chinese and Western Medicine,Qinghuangdao Hebei 066002,China)

机构地区：[1]河北港口集团有限公司秦皇岛中西医结合医院重症医学科,河北秦皇岛066002 [2]河北港口集团有限公司秦皇岛中西医结合医院心内科,河北秦皇岛066002 [3]河北港口集团有限公司秦皇岛中西医结合医院急诊科,河北秦皇岛066002

出　　处：《中国急救复苏与灾害医学杂志》2025年第3期286-289,294,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省2021年度医学科学研究课题计划项目(20211418)。

摘　　要：目的构建并验证急性ST段抬高型心肌梗死(STEMI)经皮冠状动脉介入治疗(PCI)术后心肌缺血再灌注损伤(MIRI)的风险模型。方法选取秦皇岛中西医结合医院2022年7月—2023年11月就诊的急性STEMI患者125例,所有患者均接受PCI术治疗。术后48 h内,根据急性STEMI患者是否发生MIRI分成非发生组与发生组。对比发生组与非发生组临床资料,分析急性STEMI患者PCI术后发生MIRI的影响因素,构建并验证急性STEMI患者PCI术后发生MIRI的风险模型。结果125例患者中,术后48 h内,发生MIRI 47例,剩余78例均未发生MIRI。发生组舒张压、估算的肾小球滤过率(eGFR)、收缩压、白蛋白低于非发生组(t=4.557、4.019、4.751、3.331,P<0.05),发生组血尿素氮(BUN)、有心血管不良事件、罪犯血管为右冠状动脉、Killp分级为Ⅲ~Ⅳ级例数占比、血肌酐(SCr)、年龄、B型脑钠肽(BNP)、核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)、冠状动脉狭窄率高于非发生组(P<0.05)。罪犯血管、NLRP3、年龄、冠状动脉狭窄率、BNP是急性STEMI患者PCI术后发生MIRI的影响因素(P<0.05)。列线图模型预测急性STEMI患者PCI术后发生MIRI的灵敏度为89.36%(95%CI:0.761~0.960),特异度为91.03%(95%CI:0.818~0.960),曲线下面积(AUC)为0.908(95%CI:0.851~0.965)。结论罪犯血管、NLRP3、年龄、冠状动脉狭窄率、BNP与急性STEMI患者PCI术后MIRI风险有关,构建列线图风险模型有助于早期评估急性STEMI患者PCI术后MIRI的发生风险。Objective To establish and validate the risk model of myocardial ischemia-reperfusion injury(MIRI)after percutaneous coronary intervention(PCI)for acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 125 patients with acute STEMI admitted to the hospital from July 2022 to November 2023 were selected.All patients received PCI.Within 48 hours after surgery,acute STEMI patients were divided into MIRI non-occurrence group and an occurrence group according to whether MIRI occurred.The clinical data of the occurrence group and the non-occurrence group were compared to analyze the factors affecting the occurrence of MIRI after PCI in acute STEMI patients,and establish and verify the risk model of MIRI after PCI in acute STEMI patients.Results Among the 125 patients,47 cases developed MIRI within 48 hours after operation,and the remaining 78 cases did not develop MIRI.Diastolic blood pressure,estimated glomerular filtration rate(eGFR),systolic blood pressure and albumin in the occurrence group were lower than non-occurrence group(t=4.557,4.019,4.751,3.331,P<0.05).Blood urea nitrogen(BUN),cardiovascular adverse events,culprit vessel was right coronary artery,Killp gradeⅢ-Ⅳ,serum creatinine(SCr),age,B-type brain natriuretic peptide(BNP),NOD-like receptor protein 3(NLRP3),and coronary artery stenosis rate in the occurrence group were higher than non-occurrence group(P<0.05).Criminal blood vessel,NLRP3,age,coronary artery stenosis rate and BNP were influencing factors for MIRI after PCI in acute STEMI patients(P<0.05).The sensitivity and specificity with histogram model for predicting MIRI after PCI in acute STEMI patients were 89.36%(95%CI:0.761~0.960),91.03%(95%CI:0.818~0.960),while area under the curve(AUC)was 0.908(95%CI:0.851~0.965).Conclusion Criminal blood vessels,NLRP3,age,coronary artery stenosis rate,and BNP are associated with risk of MIRI after PCI in acute STEMI patients.The construction of a nomographic risk model is helpful for early assessment with risk of MIRI after PCI in acute STE

关 键 词：急性ST段抬高型心肌梗死 列线图风险模型 经皮冠状动脉介入治疗 心肌缺血再灌注损伤 

分 类 号：R542.22[医药卫生—心血管疾病]