摘要
目的探讨急性心肌梗死(AMI)患者继发肺部感染的危险因素,并构建列线图模型。方法回顾性选取2022年4月至2025年3月达州市中心医院收治的204例AMI患者作为研究对象,根据是否继发肺部感染分为感染组和非感染组,比较两组临床资料,采用多因素Logistic逐步回归分析AMI患者继发肺部感染的影响因素;构建AMI患者继发肺部感染的列线图模型,绘制校准曲线,并采用拟合优度检验评估该模型的拟合效果,采用受试者工作特征(ROC)曲线评估列线图模型对AMI患者继发肺部感染的预测价值。结果204例AMI患者中,43例(21.08%)继发肺部感染(感染组),161例(78.92%)未继发肺部感染(非感染组)。感染组共检出58株病原菌,以革兰阴性菌为主(60.34%)。感染组男性、年龄≥60岁、糖尿病、Killip心功能分级Ⅲ~Ⅳ级、病变血管支数多支、有侵入性操作比例均大于非感染组(P<0.05),住院时间长于非感染组(P<0.05),C反应蛋白、脑钠肽(BNP)水平高于非感染组(P<0.05),白蛋白水平低于非感染组(P<0.05)。多因素Logistic逐步回归分析结果显示,年龄≥60岁、Killip心功能分级Ⅲ~Ⅳ级、侵入性操作、高水平BNP是AMI患者继发肺部感染的危险因素(P<0.05)。列线图模型拟合优度检验χ^(2)=0.752,P=0.513,提示该模型拟合程度良好。列线图模型预测AMI患者继发肺部感染的曲线下面积(95%CI)为0.902(0.851~0.953),特异度为68.55%,灵敏度为92.13%。结论AMI患者继发肺部感染的影响因素包括年龄、Killip心功能分级、侵入性操作、BNP,据此构建的列线图模型具有良好的预测性能。
Objective To analyze the risk factors for secondary pulmonary infection in patients with acute myocardial infarction(AMI)and to construct a nomogram model.Methods A total of 204 AMI patients admitted to Dazhou Central Hospital from April 2022 to March 2025 were retrospectively enrolled as subjects.They were divided into an infection group and a non-infection group based on the occurrence of secondary pulmonary infection.Clinical data were compared between the two groups.Multivariate Logistic stepwise regression analysis was used to explore the influencing factors for secondary pulmonary infection in AMI patients.A nomogram model for predicting secondary pulmonary infection in AMI patients was constructed,and a calibration curve was plotted.The goodness-of-fit test was used to evaluate the model's fit,and the receiver operating characteristic curve was used to assess the predictive value of the nomogram model.Results Among the 204 AMI patients,43(21.08%)developed secondary pulmonary infection(infection group)and 161(78.92%)did not(non-infection group).In the infection group,58 pathogenic strains were detected,predominantly Gram-negative bacteria(60.34%).Compared with the non-infection group,the infection group had a higher proportion of males,patients aged≥60 years,patients with diabetes,Killip classⅢ–Ⅳcardiac function,multi-vessel disease,and invasive procedures(all P<0.05).The infection group also had a longer hospital stay,higher levels of C-reactive protein and B-type natriuretic peptide(BNP),and a lower albumin level(all P<0.05).Multivariate Logistic stepwise regression analysis showed that age≥60 years,Killip classⅢ–Ⅳcardiac function,invasive procedures,and high BNP level were risk factors for secondary pulmonary infection in AMI patients(all P<0.05).In the goodness-of-fit test for the nomogram model,χ^(2)=0.752,P=0.513,indicating good model fit.The area under the curve(95%CI)of the nomogram for predicting secondary pulmonary infection was 0.902(0.851–0.953),with a specificity of 68.55%and a sensitivity of 92.13%.Conclusion The influencing factors for secondary pulmonary infection in AMI patients include age,Killip cardiac function classification,invasive procedures,and BNP level.The nomogram model constructed based on these factors shows good predictive performance.
作者
陈苗
冯达应
何芳
徐淼
杨冬梅
CHEN Miao;FENG Daying;HE Fang;XU Miao;YANG Dongmei(Department of Cardiovascular Medicine,Dazhou Central Hospital,Dazhou,Sichuan 635000,China)
出处
《转化医学杂志》
2026年第3期398-402,共5页
Translational Medicine Journal
基金
四川省医学科研课题计划项目(S23041)。
关键词
急性心肌梗死
肺部感染
危险因素
列线图
acute myocardial infarction
pulmonary infection
risk factor
nomogram
