急性心肌梗死后心脏游离壁破裂的风险评分模型构建与验证
Construction and validation of a risk-score model for ventricular free wall rupture after acute myocardial infarction
张程征 1李朝密 2杨阳 1崔英华1
作者信息
- 1. 济宁医学院附属医院心内监护室(山东济宁,272029)
- 2. 济宁医学院附属医院超声医学科
- 折叠
摘要
目的:构建急性心肌梗死(AMI)患者发生心脏游离壁破裂(FWR)的风险预测评分模型,并对模型进行评价和内部验证.方法:回顾性分析济宁医学院附属医院心内监护室(CCU)2010年1月-2023年8月的233例AMI患者(FWR 73例,非FWR 160例),随机分成建模组139例(FWR 43例,非FWR 96例)和验证组94例(FWR 30例,非FWR64例).建模组应用单因素分析和多因素logistic回归分析筛选出FWR的危险因素.根据各危险因素的加权赋分建立FWR风险评分模型,采用受试者工作特征(ROC)曲线下面积(AUC)和Hos-mer-Lemeshow 检验评估该模型的区分度及校准度,并在验证组中验证该模型价值.结果:建模组中多因素lo-gistic 回归分析显示:心包积液(OR=11.478,95％CI:2.881～45.732,P=0.001)、年龄≥62 岁(OR=8.930,95％CI:1.539～51.834,P=0.015)、C 反应蛋白 ≥23 mg/L(OR=28.858,95％CI:7.034～118.394,P＜0.001)、中性粒细胞百分比≥82％(OR=5.884,95％CI:1.359～25.480,P=0.018)是 FWR 的独立危险因素.基于这4个危险因素加权赋分建立评分模型,总分9分,评分≤4分划分为低风险,评分≥5分划分为高风险.本研究风险评分模型的 AUC 为 0.924(95％CI:0.879～0.968,P＜0.001),Hosmer-Lemeshow 检验(x2=4.110,P=0.847),验证组中 AUC 为 0.725(95％CI:0.613～0.837.P＜0.001),Hosmer-Lemeshow 检验(x2=2.368,P=0.796).结论:本研究建立一种新的简易的风险评分模型,对FWR有良好的预测价值,为临床实践中早期识别AMI后FWR高危患者提供了研究依据.
Abstract
Objective:To construct a score model for predicting the risk of ventricular free wall rupture(FWR)in patients after acute myocardial infarction(AMI),and to evaluate and detect with independent internal valida-tion.Methods:A total of 233 patients with AMI(FWR 73,non-FWR 160)from January 2010 to August 2023 in the Cardiac Care Unit(CCU)of the Affiliated Hospital of Jining Medical College were retrospectively analyzed,and divided into a modeling group of 139(FWR43,non-FWR96)and a validation group of 94(FWR30,non-FWR64)randomly.The risk factors of FWR were obtained by univariable and multivariable logistic regression a-nalysis in the modeling group.According to the weighted scores of each independent risk factor,the FWR risk score model was established.The discrimination and calibration of the model were detected by the area under the curve(AUC)of receiver operating characteristic(ROC)and Hosmer-Lemeshow test respectively.The value of the model was examined in the validation group.Results:In the modeling grout,the results of the multivariate logistic regression analysis showed that Pericardial effusion(OR=11.478,95％CI:2.881-45.732,P=0.001),age≥62 years old(OR=8.930,95％CI:1.539-51.834,P=0.015),CRP≥23 mg/L(OR=28.858,95％CI:7.034-118.394,P＜0.001),neutrophil percentage≥82％(OR=5.884,95％CI:1.359-25.480,P=0.018)were independent risk factors for FWR.Based on the weighting of these four risk factors,a scoring model was estab-lished with a total score of 9.The patient scores ≤4 were classified as low risk and the scores≥5 were assigned to high risk.In this research,the results of the modeling group with AUC of 0.924(95％CI:0.879-0.968,P＜0.001)and Hosmer-Lemeshow test(x2=4.110,P=0.847),while with AUC of 0.725(95％CI:0.613-0.837,P＜0.001)and Hosmer-Lemeshow test(x2=2.368,P=0.796)of the internal validation group.Conclusion:In this research,a new simple risk score model was established which demonstrated that good predictive value for FWR,and provides a certain reference for early clinical identification of high-risk patients with FWR after AMI.
关键词
急性心肌梗死/心脏游离壁破裂/危险因素/风险评分模型Key words
acute myocardial infarction/ventricular free wall rupture/risk factors/risk scoring model引用本文复制引用
出版年
2024
NETL
NSTL
万方数据