摘要
目的 探讨急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入术(PCI)后预后不良的相关因素,并构建风险预测模型。方法 回顾性分析,采集2022年10月至2024年11月南阳市中心医院收治的80例STEMI患者资料,所有患者均完成直接PCI治疗,并于治疗后完成6个月随访,根据患者随访期间预后情况分为预后不良组(18例)和预后良好组(62例),统计患者入院时资料,分析急性ST段抬高型心肌梗死患者直接PCI后预后不良的相关因素,并构建风险预测模型。结果 预后不良组入院时血清心肌肌钙蛋白I(cTnI)、氨基末端脑钠肽前体(NT-proBNP)、C反应蛋白(CRP)、纤维蛋白原(FIB)/前白蛋白(PA)水平为(2.6±0.4)μg/L、(560.9±29.2)pg/ml、(35.4±5.2)ng/L、(11.5±2.3)均高于预后良好组的(2.0±0.4)μg/L、(519.8±28.4)pg/ml、(28.3±4.3)ng/L、(8.4±1.6)(t=5.337、5.362、5.874、6.485,P均<0.05)。绘制受试者工作特征(ROC)曲线,STEMI患者患者入院时血清cTnI、NT-proBNP、CRP、FIB/PA水平均对其直接PCI后预后不良风险有一定预测价值,曲线下面积(AUC)值分别为0.815、0.849、0.842、0.890。基于入院时血清cTnI、NTproBNP、CRP,辅以FIB/PA检测值,构建列线图预测模型,通过Bootstrap法验证,结果显示,模型预测STEMI患者直接PCI后预后不良风险的C指数(95%CI)为0.987(0.967,1.000),辨别度理想;绘制校准曲线显示,校准曲线趋近于理想曲线;绘制ROC曲线,结果显示,模型预测STEMI患者直接PCI后预后不良风险的AUC(95%CI)为0.987(0.967,1.000),预测效能高。结论 FIB/PA对STEMI患者直接PCI后预后不良风险有一定价值,结合其他临床指标构建的列线图预测模型能将风险可视化,提高预测效能。
Objective To investigate the related factors of poor prognosis in patients with acute ST-segment elevation myocardial infarction after direct Percutaneous Coronary Intervention(PCI),and to construct a risk prediction model.Methods A retrospective analysis was conducted on the data of 80 STEMI patients admitted to Nanyang Central Hospital from October 2022 to November 2024.All patients completed direct PCI treatment and were followed up for 6 months after treatment.According to the prognosis during the follow-up period,they were divided into a poor prognosis group(18 cases)and a good prognosis group(62 cases).The data of patients at admission were statistically analyzed to identify the related factors of poor prognosis in patients with acute ST-segment elevation myocardial infarction after direct PCI,and a risk prediction model was constructed.Results At admission,the serum levels of cardiac troponin I(cTnI),N-terminal pro brain natriuretic peptide(NT-proBNP),C-reactive protein(CRP),and fibrinogen(FIB)/prealbumin(PA)in the poor prognosis group were(2.6±0.4)μg/L,(560.9±29.2)pg/ml,(35.4±5.2)ng/L,and(11.5±2.3),all of which were higher than those in the good prognosis group(2.0±0.4)μg/L,(519.8±28.4)pg/ml,(28.3±4.3)ng/ml,and(8.4±1.6)(t=5.337,5.362,5.874,6.485,all P<0.05).Receiver operating characteristic(ROC)curve was drawn for STEMI patients.The serum levels of cTnI,NT-proBNP,CRP,and FIB/PA at admission had certain predictive value for the risk of poor prognosis after direct PCI,and the area under the curve(AUC)values were 0.815,0.849,0.842,and 0.890,respectively.Based on serum cTnI,NT-proBNP and CRP at admission,supplemented by FIB/PA detection values,a nomogram prediction model was constructed and verified by the Bootstrap method.The results showed that the C-index(95%CI)of the model for predicting the risk of poor prognosis after direct PCI in STEMI patients was 0.987(0.967,1.000),with ideal discrimination.The calibration curve showed that it approached the ideal curve.The ROC curve was plotted.The results showed that the AUC(95%CI)of the model for predicting the risk of poor prognosis after direct PCI in STEMI patients was 0.987(0.967,1.000),indicating high predictive efficacy.Conclusion FIB/PA has certain value in predicting the risk of poor prognosis in STEMI patients after direct PCI.The nomogram prediction model,constructed by combining other clinical indicators can visualize the risk and improve prediction efficiency.
作者
李兆品
Li Zhaopin(Department of Blood Transfusion,Nanyang Central Hospital,Nanyang 473000,China)
出处
《实用医技杂志》
2025年第12期935-939,F0003,共6页
Journal of Practical Medical Techniques
