心房颤动合并冠心病患者口服抗栓药依从性影响因素的分析及列线图模型的构建  

Analysis of influencing factors and construction of column chart model for oral antithrombotic drug compliance in patients with atrial fibrillation and coronary heart disease

作　　者：玄绘弘 杨阳 邢小伟 付彬彬 董爽 孙建华 XUAN Huihong;YANG Yang;XING Xiaowei;FU Binbin;DONG Shuang;SUN Jianhua(The Third Department of Cardiology,Tangshan Workers’Hospital,Tangshan 063000,China;Department of Cardiology,Qianxi County People’s Hospital,Tangshan 063000,China)

机构地区：[1]唐山市工人医院心内三科,唐山063000 [2]唐山市迁西县人民医院心内科,唐山063000

出　　处：《西北药学杂志》2025年第2期103-111,共9页Northwest Pharmaceutical Journal

基　　金：河北省2023年度医学科学研究课题(编号:20231780)。

摘　　要：目的分析心房颤动合并冠心病患者口服抗栓药依从性的影响因素,构建并验证预测口服抗栓药依从性差风险的列线图模型。方法选取2019年10—2023年2月诊治的心房颤动合并冠心病患者作为研究对象,按照7∶3的分组比例随机分为模型组(210例)和验证组(90例),并依据药物依从性分为未依从组和依从组。收集并比较患者的临床资料,依次通过单因素和多因素Logistic回归分析筛选影响患者口服抗栓药依从性的因素,并在筛选出的因素的基础上构建并验证列线图模型。结果模型组内,未依从组“个人经济状况<5000元·月^(−1)”“自费”“独居”“有焦虑心理”“抗栓药疗程≥1年”“患者认知差”“家属认知差”的比例高于依从组(P<0.05)。多因素Logistic回归分析结果显示,“个人经济状况<5000元·月^(−1)”“自费”“独居”“抗栓药疗程≥1年”“患者认知差”“家属认知差”是模型组患者依从性差的危险因素(P<0.05)。ROC曲线分析结果显示,模型组与验证组的AUC分别为0.888(95%CI:0.846~0.931)、0.898(95%CI:0.837~0.960)。Hosmer-Lemeshow检验结果显示,模型组χ^(2)=8.149,P=0.413,验证组χ^(2)=8.062,P=0.427。结论“个人经济状况<5000元·月−1”“自费”“独居”“抗栓药疗程≥1年”“患者认知差”“家属认知差”可能是心房颤动合并冠心病患者口服抗栓药依从性差的危险因素,基于危险因素构建的列线图模型区分度、校准度和一致性良好,可在一定程度上反映个体化服药依从性差的风险。Objective To analyze the factors influencing the oral antithrombotic drug compliance in patients with atrial fibrillation and coronary heart disease,as well as to develop and validate a column chart model for predicting the risk of poor oral antithrombotic drug compliance.Methods The patients with atrial fibrillation and coronary heart disease treated in our hospital from October 2019 to February 2023 were included and randomly divided into a model group(210 cases)and a validation group(90 cases)using a 7∶3 grouping ratio.They were further categorized into a non-compliance group and a compliance group based on their adherence to medication.The clinical data of the patients were cellected and compared.The factors influencing the compliance of patients with oral antithrombotic drug were screened through univariate and multivariate Logistic regression analyses in sequence.Based on the screened factors,a column chart model was constructed and validated.Results In the model group,the non-compliance group showed higher proportions of“personal economic status<5000 yuan per month”“self-payment”“living alone”“anxiety”“antithrombotic treatment course≥1 year”“poor patient cognition”and“poor family cognition”than the compliance group(P<0.05).The results of multiple Logistic regression analysis showed that“personal economic status<5000 yuan per month”“self-payment”“living alone”“treatment of antithrombotic drugs≥1 year”“poor patient cognition”and“poor family cognition”were risk factors for poor compliance in the model group(P<0.05).The ROC curve analysis results showed that the area under the curve(AUC)of the model group and validation group were 0.888(95%CI:0.846—0.931)and 0.898(95%CI:0.837—0.960),respectively.The Hosmer-Lemeshow test results showed thatχ^(2)=8.149,P=0.413 for the model group andχ^(2)=8.062,P=0.427 for the validation group.Conclusion The risk factors for poor oral compliance to antithrombotic drug in patients with atrial fibrillation and coronar

关 键 词：心房颤动 冠心病 抗栓药 依从性 影响因素 列线图 

分 类 号：R95[医药卫生—药学]