急性ST段抬高型心肌梗死患者PCI术后预后评价模型的建立与研究

Establishment and study of prognosis evaluation model in patients with acute ST-elevation myocardial infarction after PCI

目的建立用于评价急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)术后预后的模型方程并评价其效能。方法选择2011年1月至2016年5月该院收治的STEMI且成功行PCI治疗的患者1 678例,根据其术后1年内是否发生主要不良心血管事件(MACE)分为事件组和非事件组。比较分析两组患者各项指标,通过对指标的系统性回归分析建立预后评价方程。结果多因素分析显示:心功能分级较高、高敏C反应蛋白(hs-CRP)>3mg/L、活化部分凝血活酶时间(APTT)>35s、再通时间大于6h、BNP>84ng/mL、糖尿病病史、c-TnT>0.1ng/mL是预后较差的独立危险因素。将Logistic回归分析有意义的因素代入Fisher判别方程后,成功建立预后判断方程Y=1.074×心功能分级+0.186×hs-CRP+0.393×APTT+0.105×再通时间+0.108×BNP+0.088×是否糖尿病+0.087×c-TnT。该方程ROC曲线下面积为0.897(0.860,0.935),将分界值选为0.782时,灵敏度和特异度分别为84.2%和91.6%。结论本研究建立的预后判断方程具有较好的判断效能。

Objective To establish the prognosis evaluation model for acute ST elevation myocardial infarction(STEMI)patients after percutaneous coronary intewention(PCI)which provides a reasonable basis for the rational development of clinical treatment programs.Methods A total of 1 678 STEMI patients admitted to our hospital from January 2011 to May 2016 were selected.All patients were followed up for one year.According to whether major adverse cardiovascular events(MACE)occurred within 1 year,patients were divided into event group and non-event group patients.Comparisons were made between the two groups of patients and the prognostic evaluation equation were established through the regression analysis of indicators.Results Multivariate analysis showed that highly heart function grading,hypersensitive C-reactive protein(hs-CRP)>3 mg/L,activated partial thromboplastin time(APTT)>35 s,the recanalization time>6 hours,type B natriuretic peptide(BNP)>84 ng/mL,having the history of diabetes and cardiac troponin(c-TnT)>0.1 ng/mL were independent risk factors for poor prognosis.The prognostic judgment equation was established successfully after logistic regression analysis of meaningful factors into the Fisher discriminant equation:Y=1.074×heart function grading+0.186×hs-CRP+0.393×APTT+0.105×recanalization time+0.108×BNP+0.088×diabetes history+0.087×c-TnT.The area under the ROC curve was 0.897(0.860,0.935).When the cutoff value was selected as 0.782,the sensitivity and specificity were 84.2% and 91.6%respectively.Conclusion The prognostic judgment equation established in this study has a relatively good judging efficiency.