个体化预测急性ST段抬高型心肌梗死患者发生自发再灌注的列线图模型的建立
Journal of Clinical Cardiology（2020）
Abstract
目的:建立预测急性ST段抬高型心肌梗死(STEMI)患者发生自发再灌注的个性化列线图模型.方法:选取2016年12月1日-2019年12月24日南方医科大学深圳医院收治的初发型STEMI患者108例,根据急诊冠状动脉造影TIMI评分,分为自发再灌注组(TIMI 2～3级,SR组)和无自发再灌注组(TIMI 0～1级,NSR组).通过单因素及多因素Logistic回归分析得到急性STEMI患者自发再灌注的独立预测因素,应用R语言软件建立列线图模型并对其进行验证.结果:单因素及多因素Logistic回归分析显示,年龄＜55岁(OR=1.200,95％CI:1.025～1.405)、发病至用药时间＜3.7 h(OR=3.040,95％CI:1.249～7.403)、术前ST段回落≥50％(OR=2.171,95 ％CI:1.194～3.946)、胸痛评分下降＞5分(OR=1.156,95％CI:1.100～1.215)以及肌酸激酶同工酶(CK-MB)＜185 U/L(OR=1.048,95％CI:1.002～1.095)是急性STEMI患者发生自发再灌注的独立预测因素.基于上述独立预测因素建立列线图模型,验证后发现预测值同实测值基本一致,提示预测模型拟合度良好.随后采用Bootstrap内部验证法对预测模型进行验证,C-index为0.968(95％ CI:0.916～0.997),说明该列线图预测模型预测效能高.结论:基于年龄、发病至用药时间、术前ST段回落、胸痛评分下降以及CK-MB等因素建立的个体化列线图模型预测急性STEMI患者发生自发再灌注的能力较好,临床应用价值高.
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