经皮冠状动脉支架植入术后患者发生久坐行为的决策树预测模型构建与验证  

Construction and validation of a decision tree prediction model for sedentary behavior in patients underwent percutaneous coronary stent implantation

作　　者：李菁 万栗娟 刘琳 LI Jing;WAN Li-juan;LIU Lin

机构地区：[1]江西省中西医结合医院,江西南昌330000

出　　处：《中国疗养医学》2025年第4期85-90,共6页Chinese Journal of Convalescent Medicine

摘　　要：目的 探讨经皮冠状动脉支架植入术(PCI)后患者发生久坐行为的影响因素,并构建决策树预测模型与验证。方法 回顾性选取2022年5月至2023年11月收治的176例均行PCI的患者作为研究对象,根据PCI术后是否发生久坐行为进行分组,分为久坐行为组(n=56)和非久坐行为组(n=120),分析影响PCI术后发生久坐行为的相关因素,构建决策树预测模型。另选取2023年12月至2024年6月收治的75例行PCI的患者作为验证组,使用受试者工作特征曲线(ROC)评估模型预测效能。结果 176例PCI术后的患者中发生久坐行为56例(31.82%),没有发生久坐行为120例(68.18%)。根据多因素Logistic回归分析,已婚、家庭月收入≤3 000元、慢病数量≥3种、不运动、NYHA心功能分级Ⅱ级和高水平D-二聚体为PCI术后发生久坐行为的独立危险因素,低水平社会支持评定量表(SSRS)评分是其保护因素(P<0.05)。以PCI术后发生久坐行为所占节点构成比例代表该类人群PCI术后发生久坐行为的风险,筛选出6类高危人群:(1)正常水平D-二聚体、家庭月收入≤3 000元,占该节点构成的71.40%。(2)高水平的D-二聚体、正常水平SSRS评分,占该节点构成的44.00%。(3)高水平的D-二聚体、正常水平SSRS评分、慢病数量<3种,占该节点构成的80.00%。(4)高水平的D-二聚体、低水平SSRS评分、已婚,占该节点构成的30.00%。(5)高水平的D-二聚体、低水平SSRS评分、未婚,占该节点构成的40.00%。(6)高水平的D-二聚体、低水平SSRS评分、慢病数量<3种,占该节点构成的80.00%。在ROC曲线中,训练集的AUC为0.912(95%CI:0.860,0.963),灵敏度为80.40%,特异度为92.50%;验证集的AUC为0.860(95%CI:0.749,0.970),灵敏度为69.20%,特异度为91.90%,证明模型的拟合度较好。结论 PCI术后患者发生久坐行为受到多种因素的综合影响,以相关因素构建的决策树模型能够良好预测PCI术后发生久坐行为的风险。Objective To explore the influencing factors of sedentary behavior in patients underwent percutaneous coronary intervention(PCI),and to construct and verify the decision tree prediction model.Methods A total of 176 patients who underwent PCI from May 2022 to November 2023 were retrospectively selected as the study subjects.They were divided into sedentary behavior group(n=56)and non-sedentary behavior group(n=120)according to whether sedentary behavior occurred after PCI.The related factors affecting sedentary behavior after PCI were analyzed,and the decision tree prediction model was constructed.Another 75 patients who underwent PCI from December 2023 to June 2024 were selected as the validation group,and the receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of the model.Results Of the 176 patients underwent PCI,56(31.82%)had sedentary behavior and 120(68.18%)had no sedentary behavior.The multivariate Logistic regression analysis showed married status,family monthly income of 3000 yuan,number of 3 kinds of chronic diseases,non-exercise status,gradeⅡNew York Heart Association(NYHA)cardiac function classification and high level of D-dimer were independent risk factors for sedentary behavior after PCI,and low level of the social support rating scale(SSRS)score was its protective factor(P<0.05).The proportion of nodes with sedentary behavior after PCI was used to represent the risk of sedentary behavior after PCI in this group of people.Six types of high-risk groups were screened out,including normal-level D-dimer+family monthly income of≤3000 yuan(71.40%of the node composition),high-level D-dimer+normal-level SSRS score(44.00%of the nodes),high-level D-dimer+normal-level SSRS score+<3 kinds of chronic diseases(80.00%of the node composition),high-level D-dimer+low-level SSRS score+married status(30.00%of the nodes),high-level D-dimer+low-level SSRS score+unmarried status(40.00%of the nodes),and high-level D-dimer+low-level SSRS score+<3 kinds of chronic diseases(80.00%of th

关 键 词：经皮冠状动脉支架植入术 久坐行为 影响因素 决策树 预警模型 

分 类 号：R541.4[医药卫生—心血管疾病]