發(fā)布時(shí)間：2018-03-19 21:41

  本文選題：心臟再同步治療　切入點(diǎn)：危險(xiǎn)性評估　出處：《中國循環(huán)雜志》2017年08期 　論文類型：期刊論文

【摘要】：目的:創(chuàng)建并驗(yàn)證心臟再同步化治療(CRT)患者臨床預(yù)后的風(fēng)險(xiǎn)評分系統(tǒng)。方法:連續(xù)納入2010-01至2015-12于我院首次接受CRT的患者367例。隨訪終點(diǎn)事件為全因死亡(包括心臟移植)和心力衰竭再住院。隨機(jī)選取300例患者為建模組構(gòu)建風(fēng)險(xiǎn)評分系統(tǒng),其余67例為驗(yàn)證組進(jìn)行驗(yàn)證。采用Cox風(fēng)險(xiǎn)比例回歸模型建立評分系統(tǒng);受試者工作特征(ROC)曲線下面積(AUC)評價(jià)并對比HEAL評分與EARRN評分的區(qū)分度;Hosmer-Lemeshow法評價(jià)擬合優(yōu)度;Kaplan-Meier法比較不同評分患者的臨床終點(diǎn)。結(jié)果:建模組分析顯示,高敏C反應(yīng)蛋白(HR=1.137,95%CI:1.072~1.205,P0.001)、大內(nèi)皮素-1(HR=1.934,95%CI:1.066~3.507,P=0.03)、左心房前后徑(HR=1.045,95%CI:1.007~1.084,P=0.02)、紐約心臟協(xié)會(huì)(NYHA)心功能Ⅳ級(jí)(HR=2.583,95%CI:1.331~5.013,P=0.005)是CRT患者不良預(yù)后的獨(dú)立危險(xiǎn)因素。依據(jù)危險(xiǎn)因素β偏回歸系數(shù)建立HEAL評分,根據(jù)分值劃定患者危險(xiǎn)分級(jí):4分為低危,4~10分為中危,10分為高危。低、中、高危分級(jí)在建模組和驗(yàn)證組的ROC曲線下面積分別為0.719(95%CI:0.629~0.809)和0.708(95%CI:0.539~0.878),該評分可良好地區(qū)分不同危險(xiǎn)分級(jí)患者的臨床預(yù)后(Log-rank檢驗(yàn),建模組P0.001,驗(yàn)證組P=0.002)。Hosmer-Lemeshow擬合優(yōu)度較好(P=0.952)。對367例患者分別采用HEAL評分與EARRN評分,發(fā)現(xiàn)HEAL評分(AUC:0.763,95%CI:0.692~0.833)較EARRN評分(AUC:0.602,95%CI:0.517~0.687)區(qū)分度更高。結(jié)論:HEAL評分能有效地預(yù)測CRT患者不良預(yù)后,區(qū)分度優(yōu)于EARRN評分,對于識(shí)別高危患者具有臨床實(shí)踐價(jià)值。
[Abstract]:Objective: to establish and verify a risk scoring system for clinical prognosis in patients with cardiac resynchronization therapy. Methods: 367 consecutive patients who received CRT for the first time in our hospital from 2010-01 to 2015-12 were included. Three hundred patients were randomly selected as the model group to construct a risk scoring system. The other 67 cases were verified by the validation group. The Cox risk proportional regression model was used to establish the scoring system. The area under the operating characteristic curve was evaluated and compared between HEAL scores and EARRN scores. Hosmer-Lemeshow method was used to evaluate the clinical endpoints of patients with different scores by Kaplan-Meier method. Results: modeling group analysis showed that, Gao Min C-reactive protein (HR1.137 / 95CI: 1.0721.205U P0.001), et 1.93495CI1: 1.0663.507P0.03), left atrial anterior and posterior diameter HR1.045-95: CI1.0071.084P0.02, NYHA 鈪，

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