二尖瓣关闭不全患者心脏瓣膜置换术后发生低心排综合征的相关因素及预测模型构建

doi:10.3969/j.issn.1006-6233.2022.02.024

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摘要 目的: 分析二尖瓣关闭不全(MR)患者心脏瓣膜置换术(CVR)后发生低心排综合征(LCOS)的相关因素,并构建预测模型。方法: 选取我院2018年1月至2020年12月收治的163例MR患者作为研究对象,记录患者基线资料,均行CVR治疗,记录手术相关资料,统计LCOS发生情况,患者分为发生LCOS组和未发生LCOS组,比较两组基线资料及手术相关资料,经Logistic回归分析检验MR患者CVR后发生LCOS的风险因子,构建LCOS预测模型,采用Hosmer-Lemeshow拟合优度检验,并绘制ROC曲线,评价LCOS预测模型的预测效能。结果: 163例MR患者完成CVR治疗后,28例发生LCOS,发生率为17.18%;发生LCOS组美国纽约心脏病学会(NYHA)分级、术前B型脑钠肽(BNP)、术前心肌肌钙蛋白T(cTnT)、水电解质紊乱占比高于未发生LCOS组,体外循环(CPB)时间、主动脉阻断(ACC)时间长于未发生LCOS组,术后出血量大于未发生LCOS组,术前LVEF低于未发生LCOS组(P<0.05);经Logistic回归分析结果显示,NHYA分级高、术前LVEF低、术前BNP高、术前cTnT高、水电解质紊乱、CPB时间长、ACC时间长、术后出血量大是MR患者CVR后LCOS发生的风险因子(OR>1,P<0.05);建立预测模型LCOS=0.951*NHYA分级(Ⅱ级=0,Ⅲ级=1)-0.179*术前LVEF+0.015*术前BNP+3.869*术前cTnT+1.014*水电解质紊乱(否=0,是=1)+0.084*CPB时间+0.129*ACC时间+0.298*术后出血量,预测风险值P=e^{(-17.813+LCOS)}/[e^{(-17.813+LCOS)}+1]*100%。绘制受试者工作曲线(ROC)曲线发现,LCOS预测模型用于预测MR患者CVR后LCOS发生风险的AUC为0.895,>0.80,有一定预测价值;LCOS预测模型经Hosmer-Lemeshow拟合优度检验χ²=3.324,P=0.912,P>0.05,模型矫正能力良好,拟合满意。结论: MR患者CVR后LCOS发生受多个风险因子影响,结合多个风险因子建立LCOS预测模型,对预测MR患者CVR后LCOS有一定效能。

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	李玲
	刘遵季
	郭永忠

关键词 ：二尖瓣关闭不全, 心脏瓣膜置换术, 低心排综合征

Abstract：Objective: To analyze the related factors of low cardiac output syndrome (LCOS) in patients with mitral regurgitation (MR) after cardiac valve replacement (CVR), and to build the prediction model. Methods: A total of 163 patients with MR admitted to our hospital from January 2018 to December 2020 were selected as the research subjects. The baseline data of patients were recorded. All patients were treated with CVR. The operation related data were recorded, and the occurrence of LCOS was counted. The patients were divided into LCOS group and non-LCOS group. The baseline data and operation related data were compared between the two groups. Logistic regression analysis was used to examine the risk factors of LCOS in patients with MR after CVR; the LCOS prediction model was built. Hosmer-Lemeshow goodness-of-fit test was used, and the ROC curve was plotted, to evaluate the prediction efficiency of LCOS prediction model. Results: Among 163 MR patients in this study, LCOS occurred in 28 patients after CVR treatment, the incidence was 17.18%; the proportions of New York Heart Association (NYHA) classification, preoperative B-type natriuretic peptide (BNP), preoperative cardiac troponin T (cTnT) and water electrolyte disturbance in LCOS group were higher than those in non-LCOS group; cardiopulmonary bypass (CPB) time and aortic occlusion (ACC) time were longer than those in non-LCOS group; the postoperative blood loss was greater than that in non-LCOS group, and the preoperative LVEF was lower than that in non-LCOS group (P<0.05); the results of logistic regression analysis showed that high NHYA grade, low preoperative LVEF, high preoperative BNP, high preoperative cTnT, disturbance of water and electrolyte, long CPB time, long ACC time and large postoperative blood loss were risk factors for LCOS after CVR in MR patients (OR>1, P<0.05). The predictive model LCOS=0.951*NHYA classification (grade II=0, grade III=1)-0.179* preoperative LVEF + 0.015* preoperative BNP+3.869 * preoperative cTnT+1.014 * water electrolyte disorder (no=0, yes=1)+0.084 * CPB time+0.129 * ACC time+0.298 * postoperative blood loss was established, with the predictive risk value P=e (-17.813+LCOS)/[e (-17.813+LCOS)+1]*100%. The receiver operating curve (ROC) was plotted which showed that the AUC of LCOS prediction model for predicting the risk of LCOS after CVR in MR patients was 0.895, >0.80, which had certain predictive value; the LCOS prediction model tested by Hosmer-Lemeshow goodness-of-fit test found that χ²=3.324, P=0.912, P>0.05, the model had good correction ability and satisfactory fitting. Conclusion: The occurrence of LCOS after CVR in MR patients is affected by multiple risk factors. Combined with multiple risk factors, the LCOS prediction model is built, which has certain efficiency in predicting the LCOS of MR patients after CVR.

Key words： Mitral regurgitation Cardiac valve replacement Low cardiac output syndrome

基金资助:新疆维吾尔自治区自然科学基金项目,(编号:2018D01C048);国家自然科学基金项目,(编号:81800320)

通讯作者: 郭永忠

引用本文:

李玲, 刘遵季, 郭永忠. 二尖瓣关闭不全患者心脏瓣膜置换术后发生低心排综合征的相关因素及预测模型构建[J]. 河北医学, 2022, 28(2): 295-301.
LI Ling, LIU Zunji, GUO Yongzhong. Related Factors of Low Cardiac Output Syndrome in Patients with Mitral Regurgitation After Cardiac Valve Replacement and the Construction of Prediction Model. HeBei Med, 2022, 28(2): 295-301.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.02.024 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I2/295

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