摘要
目的探讨非体外循环冠状动脉旁路移植术(OPCABG)后远期桥血管阻塞发生的危险因素,建立风险预测模型检验预测效果。方法回顾性分析2013年6月至2017年5月在聊城市人民医院行OPCABG治疗的127例冠心病患者的临床资料。统计术后5年远期桥血管阻塞发生情况,分析影响OPCABG后远期桥血管阻塞发生的相关因素,构建OPCABG后远期桥血管阻塞风险列线图模型并进行预测模型的验证及效能评估。结果127例冠心病患者共有31例出现桥血管阻塞。阻塞组女性、年龄、合并高脂血症、天门冬氨酸氨基转移酶(AST)、同型半胱氨酸(Hcy)、术后再发心绞痛高于未阻塞组(P<0.05),左心室射血分数(LVEF)则低于未阻塞组(P<0.05)。多因素分析显示,女性、年龄、LVEF及术后再发心绞痛均为OPCABG后远期桥血管阻塞发生的影响因素,[HR(95%CI)=2.942(1.242~6.966)、2.875(1.214~6.807)、2.728(1.175~6.586)、3.442(1.294~9.157),P<0.05]。以上述危险因素作为预测变量,建立列线图预测模型,各因素总分范围32~378分,对应风险率范围0.01~0.80。列线图模型验证结果显示C-index指数为0.827(95%CI=0.781~0.865),结果显示校正曲线趋近于理想曲线(P>0.05)。ROC曲线结果显示:列线图模型预测OPCABG后远期桥血管阻塞的敏感度为74.19%,特异度为84.38%,AUC为0.832(95%CI=0.756~0.893)。结论女性、年龄、LVEF及术后再发心绞痛均与OPCABG后远期桥血管阻塞发生有关,基于上述危险因素建立的列线图模型对OPCABG后远期桥血管阻塞发生的预测效能良好。
Objective To investigate the risk factors for long-term graft occlusion after offpump coronary artery bypass grafting(OPCABG),establish a risk prediction model and evaluate its predictive efficacy.Methods Clinical data of 127 patients with coronary heart disease underwent OPCABG at Liaocheng People’s Hospital from June 2013 to May 2017 were retrospectively analyzed.The occurence of long-term graft occlusion was recorded over a 5-year follow-up period.Factors affecting the occurrence of long-term graft occlusion after OPCABG were analyzed.A nomogram model for predicting the occurence of long-term graft occlusion risk after OPCABG was constructed and validated,and its efficacy was evaluated.Results Among the 127 patients with coronary heart disease,31 cases experienced graft occlusion.The proportion of females,age,comorbid hyperlipidemia,levels of aspartate aminotransferase(AST)and homocysteine(Hcy),and postoperative recurrence of angina pectoris in the occlusion group were higher than those in the non-occlusion group(P<0.05),while the left ventricular ejection fraction(LVEF)in the occlusion group was lower(P<0.05).Multivariate analysis showed that female gender,age,LVEF,and postoperative recurrence of angina pectoris were the influencing factors for long-term graft occlusion after OPCABG[HR(95%CI)=2.942(1.242-6.966),2.875(1.214-6.807),2.728(1.175-6.586),3.442(1.294-9.157);P<0.05].A nomogram prediction model was established using the above risk factors as predictive variables,with a total score ranging from 32 to 378,corresponding to a risk rate ranging from 0.01 to 0.80.The validation of the nomogram model showed a C-index of 0.827(95%CI=0.781-0.865),and the results showed that the calibration curve approached the ideal curve(P>0.05).The receiver operating characteristic(ROC)curve showed that the nomogram model had a sensitivity of 74.19%,a specificity of 84.38%,and an area under the curve(AUC)of 0.832(95%CI=0.756-0.893)for predicting long-term graft occlusion after OPCABG.Conclusion Female gender,age,LVEF,and postoperative recurrence of angina pectoris are all associated with the occurrence of long-term graft occlusion after OPCABG.The nomogram model based on these risk factors shows good predictive performance for the long-term graft occlusion after OPCABG.
作者
杨磊
许田田
栗振坤
Yang Lei;Xu Tiantian;Li Zhenkun(Department of Cardiovascular Surgery,Liaocheng People’s Hospital,Liɑocheng 252000,China;Department of Pathology,Liaocheng People’s Hospital,Liɑocheng 252000,China)
出处
《心脑血管病防治》
2023年第9期20-23,61,共5页
CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT
