作者：蓝璧高，林陆韬

单位：

546300广西壮族自治区河池市第一人民医院心血管内科 通信作者：蓝璧高，E-mail：lidongybj71@163.com

单位（英文）：

Department of Cardiology, Hechi First People's Hospital, Hechi 546300, China Corresponding author: LAN Bigao, E-mail: lidongybj71@163.com

关键词：

心肌梗死; ST段抬高型心肌梗死; 冠状动脉介入治疗; Q波; 列线图模型;

关键词（英文）：

Myocardial infarction; ST-segment elevation myocardial infarction; Percutaneous coronary intervention;Q wave; Nomogram model

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2022.00.060

基金项目：

摘要：

目的 分析ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后发生Q波形成的影响因素，并构建其列线图模型。方法 选取2017年3月至2021年3月河池市第一人民医院收治的533例行PCI的STEMI患者作为研究对象，根据PCI后有无Q波形成将其分为Q波形成组（n=164）和无Q波形成组（n=369）。收集患者的基线资料及PCI前心功能指标[左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）]、心肌损伤标志物[天冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、肌酸激酶、肌酸激酶同工酶、心肌肌钙蛋白I(cTnI)]、血红蛋白。STEMI患者PCI后发生Q波形成的影响因素分析采用多因素Logistic回归分析。采用R软件的“rms”程序包构建STEMI患者PCI后Q波形成发生风险的列线图模型；采用Bootstrap法重复抽样1 000次进行验证，计算一致性指数（CI），绘制校正曲线以分析该列线图模型的预测结果与实际结果的一致性；采用“rmda”软件包绘制决策曲线，分析该列线图模型预测STEMI患者PCI后发生Q波形成的净获益率。结果 本组533例STEMI患者PCI后发生Q波形成164例，Q波形成发生率为30.77%。Q波形成组年龄大于无Q波形成组，男性占比和吸烟、合并糖尿病、TIMI血流分级为0～2级者占比及脑钠肽高于无Q波形成组，STB时间长于无Q波形成组，血红蛋白低于无Q波形成组（P<0.05）。多因素Logistic回归分析结果显示，年龄、吸烟、STB时间、脑钠肽、血红蛋白是STEMI患者PCI后发生Q波形成的独立影响因素（P<0.05）。基于上述影响因素构建STEMI患者PCI后Q波形成发生风险的列线图模型，结果显示，CI为0.976，该列线图模型预测STEMI患者PCI后发生Q波形成的校正曲线趋近于理想曲线；ROC曲线分析结果显示，该列线图模型预测STEMI患者PCI后发生Q波形成的AUC为0.976，最佳截断值为0.402，灵敏度为0.915，特异度为0.935。决策曲线分析结果显示，阈值为0～1.0范围内，该列线图模型预测STEMI患者PCI后发生Q波形成的净获益率>0，最大净获益率为0.308。结论 年龄、吸烟、STB时间、脑钠肽、血红蛋白是STEMI患者PCI后发生Q波形成的独立影响因素，基于上述影响因素构建的列线图模型具有较高的预测效能，且具有可行性。

英文摘要：

【Abstract】　Objective To analyze the influencing factors of Q wave formation in patients with ST-segment elevationmyocardial infarction (STEMI) after percutaneous coronary intervention (PCI) , and construct its risk prediction nomogram model.MethodsA total of 533 STEMI patients undergoing PCI from March 2017 to March 2021 in Hechi First People's Hospital wereselected as the research subjects. According to whether Q wave formed after PCI, they were divided into Q wave formation group(n=164) and non Q wave formation group (n=369) . The baseline data, cardiac function indexes [left ventricular ejection fraction(LVEF) , left ventricular end diastolic diameter (LVEDD) , left ventricular end systolic diameter (LVESD) ] , myocardial injurymarkers [aspartate aminotransferase (AST) , lactate dehydrogenase (LDH) , creatine kinase, creatine kinase isoenzyme, cardiactroponin I (cTnI) ] and hemoglobin of patients before PCI were collected. The influencing factors of Q wave formation in STEMIpatients after PCI were analyzed by multivariate Logistic regression analysis, and the nomogram model of occurence risk of Q waveformation in STEMI patients after PCI was constructed by using the "rms" package of R software; the consistency index (CI) wascalculated by repeated sampling 1 000 times by Bootstrap method. The calibration curve was drawn to analyze the consistencybetween the predicted results of the nomogram model and the actual results; the decision curve was drawn by "rmda" softwarepackage to predict the net benefit rate of the nomogram model of occurence risk of Q wave formation in STEMI patients after PCI.Results There were 164 cases of Q wave formation after PCI in 533 patients with STEMI. The incidence of Q wave formation was30.77%. The age of the Q wave formation group was larger than that of the non Q wave formation group, the proportion of patientswith male, smoking, diabetes mellitus, grade 0-2 of TIMI blood flow were higher than those of the non Q wave formation, STB timewas longer than that of the non Q wave formation, hemoglobin was lower than that of the non Q wave formation group (P < 0.05) .Multivariate Logistic regression analysis results showed that age, smoking, STB time, brain natriuretic peptide and hemoglobinwere independent influencing factors of Q wave formation in patients with STEMI after PCI (P < 0.05) . Based on the aboveinfluencing factors, a nomogram model of occurrence risk of Q wave formation in STEMI patients after PCI was constructed. Theresults showed that the CI was 0.976, and the correction curve of the nomogram model for predicting the risk of Q wave formationwas closed to the ideal curve; ROC curve analysis results showed that the AUC of Q wave formation in STEMI patients after PCIpredicted by the nomogram model was 0.976, the best cut-off value was 0.402, the sensitivity was 0.915 and the specificity was0.935. The results of decision curve analysis showed that within the threshold range of 0-1.0, the net benefit rate of the nomogrammodel for predicting the Q wave formation in STEMI patients after PCI was > 0, and the maximum net benefit rate was 0.308.Conclusion Age, smoking, STB time, brain natriuretic peptide and hemoglobin are independent influencing factors of Q waveformation in patients with STEMI after PCI, and nomogram model of occurence risk of Q wave formation in STEMI patients afterPCI constructed based on the above influencing factors has good prediction efficiency, and can obtain a high net benefit rate.

参考文献：