摘要
目的:建立并验证心脏黏液瘤患者并发血管栓塞的风险评分系统。方法:回顾性分析2000年1月至2020年1月南昌大学第二附属医院300例行手术治疗并经病理确诊为心脏黏液瘤患者的临床资料。从研究对象中随机抽取70%病例(210例)作为建模人群,建模人群根据患者的临床表现及影像学检查结果,将合并血管栓塞的心脏黏液瘤患者纳入栓塞组(n=42),不合并血管栓塞的心脏黏液瘤患者纳入未栓塞组(n=168)。剩余30%的研究对象(90例)为验证人群。采用Logistic回归分析筛选出心脏黏液瘤患者并发血管栓塞的独立危险因素,并获得相应的回归系数。以回归系数为基础建立风险评分系统,并进行建模人群和验证人群验证。结果:(1)评分系统的建立与建模人群:建立的评分系统由年龄、吸烟、心房颤动、肿瘤形态、肿瘤结构五个变量组成,分值范围为0~8分,其校准度良好(P>0.05),区分度良好(ROC曲线AUC为0.835,95%CI:0.768~0.902,P<0.01)。以4分为界值,将心脏黏液瘤患者分为高风险及低风险人群,其诊断敏感度、特异度、准确性、阳性预测值、阴性预测值分别为73.81%、78.00%、77.14%、45.59%、92.25%;阳性似然比和阴性似然比分别为3.36、0.34。(2)该评分系统的验证人群结果显示,评分系统具有良好的校准度(P>0.05)及区分度(ROC曲线AUC为0.806,95%CI:0.714~0.899,P<0.01),以4分为界值,评分系统的诊断敏感度、特异度、准确性、阳性预测值、阴性预测值分别为59.09%、80.88%、75.56%、50.00%、85.94%;阳性似然比和阴性似然比分别为3.09、0.51。结论:本研究所建立的心脏黏液瘤患者并发血管栓塞的评分系统具有良好的校准度和区分度,评分≥4分的心脏黏液瘤患者并发血管栓塞风险较高,应积极进行手术治疗。
Objectives:To establish and validate the scoring system for the risk of vascular embolism(VE)in patients with cardiac myxoma(CM).Methods:We retrospectively analyzed the clinical data of 300 CM patients in the Second Affiliated Hospital of Nanchang University,210 patients were taken as scoring system establishment cohort(VE=42,non-VE=168),the remaining 90 CM patients were taken as scoring system validation cohort.Independent risk factors and the regression coefficients for VE in CM patients were identified by logistic regression analysis.A scoring system was established based on each regression coefficient,and the scoring system was validated accordingly.Results:The scoring system,which was scored from 0 to 8 points,included 5 variables:age,smoking,atrial fibrillation,tumor morphology and tumor structure.The system had good calibration(P>0.05)and good discrimination efficacy(AUC=0.835,95%CI:0.768-0.902,P<0.01).When score 4 was used as the predictive cut-off value,the sensitivity,specificity,consistent rate,positive predictive value,negative predictive value were 73.81%,78.00%,77.14%,45.59%,92.25%,respectively;the positive likelihood ratio and negative likelihood ratio were 3.36 and 0.34,respectively.Validation results on validation cohort showed that the scoring system had good calibration(P>0.05)and good discrimination efficacy(AUC=0.806,95%CI:0.714-0.899,P<0.01).When score 4 was used as the predictive cut-off value,the sensitivity,specificity,consistent rate,positive predictive value and negative predictive value were 59.09%,80.88%,75.56%,50.00%,85.94%,respectively;the positive likelihood ratio and negative likelihood ratio were 3.09 and 0.51,respectively.Conclusions:The scoring system established in this study has good calibration and discrimination efficacy.The CM patients with score>3 points have higher risk of VE,they should thus be actively treated by surgical intervention.
作者
平璐依
郭良云
章春泉
杨璨莹
刘燕娜
PING Luyi;GUO Liangyun;ZHANG Chunquan;YANG Canying;LIU Yanna(Department of Ultrasound,The Second Affiliated Hospital of Nanchang University,Nanchang(330006),Jiangxi,China)
出处
《中国循环杂志》
CSCD
北大核心
2021年第10期997-1002,共6页
Chinese Circulation Journal
关键词
心脏黏液瘤
血管栓塞
危险因素
评分系统
cardiac myxoma
vascular embolization
risk factor
scoring system
