摘要
目的本研究结合冠状动脉计算机断层扫描血管成像(CCTA)解剖特征与围手术期临床指标,系统分析了糖尿病患者非心脏手术后心肌损伤(MINS)的危险因素,构建新型预测模型来预测糖尿病人群的MINS。方法选取2023年1月1日至2023年9月30日山东第一医科大学附属省立医院所有非心脏手术术前6个月内行冠状动脉CT血管造影的糖尿病患者242例,收集临床资料进行回顾性分析。根据是否发生MINS,将患者分为MINS组(n=54)和无MINS组(n=188)。使用LASSO和Logistic回归分析糖尿病患者MINS的危险因素,并进行列线图预测模型的构建。结果LASSO回归分析发现左前降支病变、利尿剂、冠脉病变支数、冠脉支架置入史、贫血、总胆固醇、收缩压是显著的预测因子。多因素Logistic回归分析显示,左前降支病变、冠脉支架置入史、利尿剂使用、收缩压、贫血为糖尿病患者MINS的独立危险因素。其中左前降支病变的患者风险是无病变患者的2.49倍(OR=2.49,95%CI为1.24~5.04,P=0.011)。列线图模型验证结果显示,原始受试者工作特征曲线(ROC)曲线下面积(AUC)值为0.778(95%CI为0.709~0.847),敏感度为0.702,特异度为0.686,利用Bootstrap方法进行1000次重采样内部验证,得到的平均AUC为0.765(95%CI为0.738~0.782),说明该模型具有良好的区分能力;Hosmer-Lemeshow拟合优度检验结果显示,χ^(2)=11.416,P=0.179,提示本研究数据与真实数据拟合度良好。决策曲线分析(DCA)显示当阈值范围在0.1和0.9之间时,该模型提供的净收益显著高于基线策略。表明该模型对糖尿病患者MINS有一定的预测价值。结论左前降支病变对糖尿病患者MINS有一定的预测价值,结合围手术期危险因素建立的预测模型能够预测糖尿病患者MINS的发生风险。
Objective To investigate risk factors for postoperative myocardial injury in diabetic patients and construct a predictive model for myocardial injury after non-cardiac surgery(MINS)in diabetic patients through the integration of coronary computed tomography angiography(CCTA)anatomical features and perioperative clinical indicators.Methods A retrospective analysis was conducted on 242 diabetic patients who underwent non-cardiac surgery and preoperative CCTA within six months at Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 1st to September 30th,2023.Patients were classified into MINS group(n=54)and non-MINS group(n=188),according to whether MINS occurs.LASSO regression and multivariable logistic regression were used to identify risk factors for postoperative myocardial injury in diabetic patients,followed by nomogram construction.Results LASSO regression identified left anterior descending lesions,diuretic dosage,number of diseased vessels,coronary stent history,anemia,total cholesterol,and systolic blood pressure as key predictors.Multivariable logistic regression confirmed left anterior descending lesions(OR=2.49,95%CI 1.24-5.04,P=0.011),coronary stent history,diuretic dosage,systolic blood pressure,and anemia as independent risk factors.The nomogram demonstrated good discrimination(AUC=0.778,95%CI 0.709-0.847;sensitivity=0.702,specificity=0.686)and internal validation consistency(mean bootstrapped AUC=0.765,95%CI 0.738-0.782).Hosmer-Lemeshow test indicated adequate calibration(χ^(2)=11.416,P=0.179).Decision curve analysis(DCA)revealed superior net benefit within a threshold probability range from 0.1 to 0.9.Conclusion Left anterior descending lesions are predictive of MINS in diabetic patients.The integrated model combining perioperative factors effectively stratifies MINS risk in diabetic patients.
作者
丁睿达
吕蒙
王栋
王月兰
DING Ruida;LYU Meng;WANG Dong;WANG Yuelan(Department of Anesthesiology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021;Graduate Department of Shandong First Medical University&Shandong Academy of Medical Sciences,Jinan 250117;Department of Anesthesia and Perioperative Medicine,The First Affiliated Hospital of Shandong First Medical University,Jinan 250014,China)
出处
《麻醉安全与质控》
2025年第5期369-375,共7页
Perioperative Safety and Quality Assurance
基金
山东第一医科大学学术提升计划(2019QL015)
山东省自然科学基金青年项目(ZR2021QH194)。
