预测高血压合并冠心病PCI术后支架内再狭窄nomogram模型的建立与验证
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(阜阳市第二人民医院心血管科,安徽省阜阳市 236000)

作者简介:

贾蕾蕾,硕士,副主任医师,研究方向为冠状动脉介入治疗,E-mail:jialeilei1536@126.com。通信作者张标,副主任医师,研究方向为冠心病,E-mail:1085903759@qq.com。

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Establishment and validation of a nomogram model for predicting in-stent restenosis after PCI in patients with hypertension and coronary heart disease
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Affiliation:

Cardiovascular Division, Second People's Hospital of Fuyang City, Fuyang, Anhui 236000, China)

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    摘要:

    目的]分析高血压合并冠心病经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的危险因素,并构建nomogram预警模型。 [方法]选取阜阳市第二人民医院2020年6月—2022年3月收治的182例高血压合并冠心病PCI术后患者作为研究对象,根据术后是否发生ISR将其分为ISR组(n=42)和非ISR组(n=140)。分析所选患者的临床资料,采用单因素分析、LASSO和Logistic回归分析筛选高血压合并冠心病PCI术后发生ISR的危险因素,根据危险因素构建nomogram预警模型并进行拟合优度检验。 [结果]本研究共纳入182例高血压合并冠心病PCI术后患者,发生ISR有42例,发生率为23.08%;单因素分析、LASSO回归分析显示,两组糖尿病、长期吸烟、支架直径、支架长度、高尿酸、高敏C反应蛋白(hs-CRP)、血清淀粉样蛋白A(SAA)及脂蛋白(a)水平差异有统计学意义(P<0.05)。Logistic回归分析显示,糖尿病(OR=4.4,5%CI:1.733~11.498,P=0.002)、长期吸烟(OR=4.8,5%CI:1.812~11.921,P=0.001)、支架直径≤3 mm(OR=4.4,5%CI:1.692~10.947,P=0.002)、高尿酸(OR=2.0,5%CI:1.092~6.826,P=0.032)、hs-CRP>10 g/L(OR=3.3,5%CI:1.493~10.574,P=0.006)、SAA≥10 mg/L(OR=6.8,5%CI:2.394~17.640,P=0.000)及脂蛋白(a)≥300 mg/L(OR=2.5,5%CI:1.209~7.319,P=0.018)是高血压合并冠心病PCI术后发生ISR的独立危险因素。基于7项独立危险因素建立高血压合并冠心病PCI术后发生ISR的nomogram预警模型验证结果显示,C-index为0.864(95%CI:0.831~0.897),校正曲线的预测值与实测值基本一致,AUC为0.834(95%CI:0.806~0.862),决策曲线显示阈值概率在3%~100%范围内时,具有较高的净获益值。 [结论]糖尿病、长期吸烟、支架直径≤3 mm、高尿酸、hs-CRP>10 g/L、SAA≥10 mg/L、脂蛋白(a)>300 mg/L是高血压合并冠心病PCI术后发生ISR的独立危险因素,基于上述危险因素建立的nomogram模型可准确评估和量化高血压合并冠心病PCI术后发生ISR的风险。

    Abstract:

    Aim To analyze the risk factors of hypertension with coronary heart disease after percutaneous coronary intervention (PCI) and construct a nomogram warning model for in-stent restenosis (ISR). Methods A total of 182 patients with hypertension and coronary heart disease after PCI in the Second People's Hospital of Fuyang City from June 2020 to March 2022 were selected as the research subjects, and they were divided into ISR group (n=42) and non-ISR group(n=140) according to whether ISR occurred after operation or not. The clinical data of the selected patients were analyzed. Univariate, LASSO and Logistic regression analysis were used to screen the risk factors for ISR after PCI with breast hypertension and coronary heart disease. According to the risk factors, a nomogram early warning model was constructed and a goodness-of-fit test was performed. Results A total of 182 patients with hypertension and coronary heart disease after PCI were included in this study, and 42 cases of ISR were confirmed by relevant tests, and the incidence rate was 23.08%. There were differences in smoking, stent diameter, stent length, high uric acid, high sensitivity C-reactive proein (hs-CRP) level, serum amyloid A (SAA) level, and lipoprotein(a) level in the two groups (P<0.05). Logistic regression analysis showed that diabetes (OR=4.4,5%CI:1.733~11.498, P=0.002), long-term smoking (OR=4.8,5%CI:1.812~11.921, P=0.001), stent diameter ≤ 3 mm (OR=4.4,5%CI:1.692~10.947, P=0.002), high uric acid (OR=2.0,5%CI:1.092~6.826, P=0.032), hs-CRP>10 g/L (OR=3.3,5%CI:1.493~10.574, P=0.006), SAA≥10 mg/L (OR=6.8,5%CI:2.394~17.640, P=0.000) and lipoprotein(a)≥300 mg/L (OR=2.5,5%CI:1.209~7.319, P=0.018) were the incidences of hypertension complicated with coronary heart disease after PCI independent risk factors for ISR. The nomogram early warning model for ISR after PCI for hypertension and coronary heart disease was established based on 7 independent risk factors. The validation results showed that the C-index was 0.864 (95%CI:0.831~0.897), the predictive value of the calibration curve was basically consistent with the measured value, the area under curve (AUC) was 0.834 (95%CI:0.806~0.862), and the decision curve showed that when the threshold probability was in the range of 3% to 100%, there was a higher net benefit value. Conclusions Diabetes mellitus, long-term smoking, stent diameter ≤ 3 mm, high uric acid, hs-CRP>10 g/L, SAA≥10 mg/L, lipoprotein(a)>300 mg/L are independent risks of ISR after PCI with hypertension and coronary heart disease. The nomogram model established based on the above risk factors can accurately assess and quantify the risk of ISR after PCI with hypertension and coronary heart disease.

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贾蕾蕾,张标.预测高血压合并冠心病PCI术后支架内再狭窄nomogram模型的建立与验证[J].中国动脉硬化杂志,2023,(2):148~156.

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  • 收稿日期:2022-07-23
  • 最后修改日期:2022-10-23
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  • 在线发布日期: 2023-01-12