基于血清学及心功能指标建立心脏瓣膜置换术患者预后预测模型的研究

郭小峰; 陈兴澎; 李斌

doi:10.13201/j.issn.1001-1439.2019.05.018

基于血清学及心功能指标建立心脏瓣膜置换术患者预后预测模型的研究

- 郑州大学附属洛阳中心医院心脏外科(河南洛阳, 471000)

详细信息

通讯作者: 郭小峰,E-mail:ma64882044@163.com

中图分类号: R542.5

收稿日期: 2018-09-26

Establishment of a 2-year prognosis prediction model based on serology and cardiac function indexes for patients after cardiac valve replacement

- Department of Cardiac Surgery, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, 471000, China

More Information

Corresponding author: GUO Xiaofeng, E-mail: ma64882044@163.com

Received Date: 26 September 2018

摘要

摘要: 目的：探讨心脏瓣膜置换术患者预后的影响因素，构建基于血清学、心功能指标的预测模型，为临床上防治不良预后提供参考。方法：对2010-01-2016-01接受人工瓣膜置换术的254例心脏瓣膜病患者进行分析，统计术后存活情况、手术相关指标、出院时血清学及心功能相关指标等。采用Cox风险比例模型分析预后的影响因素，并构建预测模型，通过受试者工作曲线（ROC）分析该模型对患者术后2年预后的预测作用。结果：患者术后2年的病死率为9.84%（25/254）。术前年龄、术前NYHA分级、伴糖尿病、伴肾损伤、体外循环时间、出院时肌酸激酶同工酶（CK-MB）、出院时胱抑素C （CysC）、出院时左室射血分数（LVEF）均为患者预后的独立影响因素（P<0.05）。预后预测模型：风险评分=0.777×术前年龄（>65岁=1，≤65岁=0）+1.060×术前NYHA分级（Ⅳ级=1，Ⅰ~Ⅲ级=0）+1.215×伴糖尿病（是=1，否=0）+1.341×伴肾损伤（是=1，否=0）+0.275×体外循环时间（>120 min=1，≤120 min=0）+0.341×出院时CK-MB （>13.1 U/L=1，≤13.1 U/L=0）+0.443×出院时CysC （>1.385 mg/L=1，≤1.385 mg/L=0）-0.337×出院时LVEF （>50%=1，≤50%=0）。该模型预测患者2年预后的ROC曲线面积0.721，最佳阶段值3分，其敏感度0.600，特异度0.871。结论：心脏瓣膜置换术患者预后的独立影响因素包括术前年龄、术前NYHA分级、伴糖尿病、伴肾损伤、体外循环时间、出院时CK-MB、出院时CysC、出院时LVEF，利用上述因素建立模型，有助于预测患者的2年预后。
- 心脏瓣膜病 /
- 心脏瓣膜置换术 /
- 预后 /
- 危险因素 /
- 风险评估模型
Abstract: Objective: To explore the prognostic factors for patients after cardiac valve replacement and to construct a predictive model based on serological and cardiac function indicators.Method: A retrospective analysis was made on 254 patients with valvular heart disease treated with prosthetic valve replacement from January 2010 to January 2016.Cox proportional hazard model was used to analyze the influencing factors of prognosis, and a predictive model was constructed.The predictive effect of the model for the prognosis of patients within 2 years after surgery was analyzed by receiver operating characteristic (ROC) curve.Result: The mortality of 2 years after operation was 9.84%(25/254).Preoperative age, preoperative NYHA grade, diabetes mellitus, renal injury, cardiopulmonary bypass time, creatine kinase isoenzymes (CK-MB) at discharge, Cystatin C (CysC) at discharge and left ventricular ejection fraction (LVEF) at discharge were independent prognostic factors (P<0.05).Prognostic predictive model:risk score=0.777×preoperative age (>65 years old=1, ≤ 65 years old=0) +1.060×preoperative NYHA grading (gradⅣ=1, gradeⅠ~Ⅲ=0)+1.215×diabetes mellitus (with=1, without=0) +1.341×kidney injury (with=1, without=0) +0.275×cardiopulmonary bypass time (>120 min=1, ≤ 120 min) +0.341×CK-MB (>13.1 U/L=1, ≤ 13.1 U/L=0) +0.443×CysC (>1.385 mg/L=1, ≤ 1.385 mg/L=0)-0.337× LVEF (>50%=1, ≤ 50%=0).The area of ROC curve of this model for the prognosis of patients within 2 years after surgery was 0.721, the best cutoff value was 3, the sensitivity was 0.600, and the specificity was 0.871.Conclusion: Preoperative age, preoperative NYHA grade, diabetes mellitus, renal injury, cardiopulmonary bypass time, CK-MB at discharge, CysC at discharge and LVEF at discharge were independent prognostic factors for the prognosis of patients after cardiac valve replacement.The model based on these factorsis helpful to predict the prognosis of patients within 2 years after surgery.
- valvular heart disease /
- heart valve replacement /
- prognosis /
- risk factors /
- risk assessment model

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