首页|血清尿酸/白蛋白比值预测ST段抬高型心肌梗死患者PCI术后急性肾损伤的多模型研究

血清尿酸/白蛋白比值预测ST段抬高型心肌梗死患者PCI术后急性肾损伤的多模型研究

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目的 探讨血清尿酸/白蛋白比值(sUAR)预测急性ST段抬高型心肌梗死(STEMI)患者PCI后急性肾损伤(AKI)的模型。方法 回顾性选取2021 年 7 月—2023 年 7 月都昌县人民医院收治的 166 例STEMI患者,根据PCI术后是否发生AKI分为发生组(34 例)与未发生组(132 例)。比较两组基线资料、生化指标及sUAR。采用单因素、多因素Logistic回归分析PCI术后AKI危险因素,构建列线图预测模型。建立ROC曲线分析该模型的预测效能。结果 两组年龄、高血压、Killip分级、NLR、sUAR、LVEF、造影剂剂量、PCI手术时长、多支血管病变比较,差异有统计学意义(P<0。05)。年龄偏大(OR=1。066)、Killip分级≥2(OR =7。174)、NLR升高(OR =4。440)、sUAR升高(OR =2。071)、造影剂剂量偏高(OR=1。104)、PCI 手术时长增加(OR =1。044)为 PCI 术后 AKI 的独立危险因素(P<0。05)。NLR、sUAR、"NLR+sUAR"及列线图预测模型的AUC分别为 0。807(95%CI:0。717~0。897)、0。810(95%CI:0。729~0。892)、0。877(95%CI:0。808~0。946)、0。940(95%CI:0。901~0。979)。Bootstrap(B =1 000)内部验证显示,Bias-corrected预测曲线与Ideal线基本重合,列线图风险预测模型预测能力较好;决策曲线显示,该模型的阈值概率范围为 0。01~0。90,其净收益率>0。结论 年龄、Killip分级、NLR、sUAR、造影剂剂量、PCI手术时长与STEMI患者PCI术后AKI密切相关。列线图预测模型相较于单项对PCI术后AKI有更高预测效能,临床应用价值较好。
A multi-model study of serum uric acid/albumin ratio in predicting acute kidney injury after PCI in STEMI patients
Objective To explore the potential of serum uric acid/albumin ratio(sUAR)as a predictive model for acute kidney injury(AKI)after PCI in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 166 STEMI patients admitted to Duchang Hospital from July 2021 to July 2023 were retrospectively selected and divided into two groups:the occurrence group(n =34)and the non-occurrence group(n =132)based on whether AKI occurred after PCI.Base-line data,biochemical indexes,and sUAR were compared between the two groups.Univariate and multivariate logistic regression were utilized to analyze the risk factors for AKI following PCI,and a nomogram prediction model was developed.The ROC curve was developed to analyze the predictive efficiency of the model.Results There were significant differences in age,hypertension,Killip classification,NLR,sUAR,LVEF,contrast agent dose,PCI operation time,and multi-vessel lesions between the two groups(P<0.05).Older age(OR=1.066),Killip grade≥2(OR=7.174),elevated NLR(OR=4.440),increased sUAR(OR=2.071),high contrast agent dose(OR=1.104),and prolonged PCI operation duration(OR=1.044)were identified as the independent risk factors for AKI following PCI(P<0.05).The AUC values for the NLR,sUAR,"NLR+sUAR"and no-mogram prediction models were 0.807(95%CI:0.717~0.897),0.810(95%CI:0.729~0.892),0.877(95%CI:0.808~0.946),0.940(95%CI:0.901~0.979),respectively.Bootstrap(B =1 000)internal validation indicated that the bias-corrected prediction curve was closely aligned with the ideal line,and the nomogram risk prediction model had good predictive a-bility.The decision-making curve analysis revealed that the model's threshold probability ranged from 0.01 to 0.90 with a net re-turn more than 0.Conclusion AKI after PCI in STEMI patients are closely related to such indicators as age,Killip classifica-tion,NLR,sUAR,contrast agent dose,and PCI operation duration.The nomogram prediction model demonstrates higher predic-tive efficiency for AKI after PCI compared to the single model and it holds better clinical application value.

Acute ST-segment elevation myocardial infarctionPercutaneous coronary interventionSerum uric acidAlbuminAcute kidney injuryPrediction model

张挺挺、王龙林、王贵平

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都昌县人民医院 江西都昌 332600

急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 血清尿酸 白蛋白 急性肾损伤 预测模型

江西省卫生计生委科技计划项目

20167156

2024

现代医院
广东省医院协会

现代医院

影响因子:1.332
ISSN:1671-332X
年,卷(期):2024.24(2)
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