AMI急诊PCI术后造影剂肾病的列线图预测模型研究

裴丽峰; 薛叶; 韩英

doi:10.13898/j.cnki.issn.1000-2200.2022.03.007

AMI急诊PCI术后造影剂肾病的列线图预测模型研究

Study on a nomogram prediction model for contrast-induced nephropathy after emergency PCI in AMI patients

摘要

摘要:
目的探讨急性心肌梗死(AMI)病人急诊经皮冠状动脉介入治疗(PCI)术后造影剂肾病(CIN)的发生率和主要危险因素，并建立定量列线图风险预测模型指导临床应用。
方法选取行急诊PCI治疗的AMI病人1 417例为研究对象，将病人分为CIN组180例和无CIN组1 237例。采用单因素和多因素logistic回归分析筛选主要危险因素，并建立列线图模型，受试者工作特征(ROC)曲线分析预测效能，Hosmer-Lemeshow检验计算拟合优度。根据列线图评分分为低风险、中风险和高风险病人，比较组间CIN发生率。
结果与无CIN组相比，CIN组病人年龄>75岁增多，舒张压、术前血肌酐、总胆红素、球蛋白、肌酸激酶同工酶和C反应蛋白水平升高，左心室射血分数(LVEF) < 40%、肾小球滤过率(eGFR) < mL·min^-1·1.73 m^-2、二甲双胍应用率和造影剂用量>300 mL增多，手术时间、靶血管数目、尿酸、尿素氮、白蛋白、低密度脂蛋白减少，空腹血糖降低，差异均有统计学意义(P < 0.05~P < 0.01)。多因素回归分析显示，LVEF < 40%、eGFR < mL·min^-1·1.73 m^-2和造影剂用量>300 mL是CIN的主要危险因素(P < 0.01)。ROC曲线分析列线图的预测效能为0.867，明显高于内部验证Mehran评分的预测效能0.712(P < 0.01)；校正曲线显示，预测结果和实际结果有较好的一致性。高风险病人CIN发生率明显高于中风险病人，中风险病人CIN发生率明显高于低风险病人(P < 0.01)。
结论AMI病人急诊PCI术后有较高的CIN发生率，LVEF < 40%、eGFR < mL·min^-1·1.73 m^-2和造影剂用量>300 mL是主要危险因素，定量列线图风险预测模型有较好的预测效能，值得推广应用。

Abstract:
ObjectiveTo investigate the incidence and main risk factors of contrast-induced nephropathy(CIN) after emergency percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI), and establish a quantitative nomogram risk prediction model to guide clinical application.
MethodsA total of 1 417 patients with AMI undergoing PCI were selected as the study subjects, and the patients were divided into CIN group(n=180) and non-CIN group(n=1 237).Univariate and multivariate logistic regression analysis were used to screen the main risk factors, and a nomogram model was established.The receiver operating characteristic(ROC) curve was applied to analyze the predictive efficacy, and Hosmer-Lemeshow test was used to calculate the goodness of fit.According to the nomogram score, the patients were divided into low-risk, medium-risk and high-risk group, and the incidence of CIN was compared among the groups.
ResultsCompared with the non-CIN group, the patients in the CIN group with age >75 years old increased, the level of diastolic blood pressure, preoperative serum creatinine, total bilirubin, globulin, creatine kinase isoenzyme and C-reactive protein increased, and the left ventricular ejection fraction(LVEF) < 40%, glomerular filtration rate(eGFR) < mL·min^-1·1.73 m^-2, metformin application rate and contrast dosage >300 mL increased, but the operation time, number of target vessels, uric acid, urea nitrogen, albumin, low density lipoprotein and fasting blood glucose decreased, and the differences of which were statistically significant(P < 0.05 to P < 0.01).Multivariate regression analysis showed that LVEF < 40%, eGFR < mL·min^-1·1.73 m^-2 and contrast dosage >300 mL were the main risk factors for CIN(P < 0.01).The predictive efficacy of nomogram by ROC curve analysis was 0.867, which was significantly higher than that of the internal validation Mehran score(0.712)(P < 0.01).The calibration curve showed that the predicted results were in good agreement with the actual results.The incidence of CIN in high-risk patients was significantly higher than that in medium-risk patients, and the incidence of CIN in medium-risk patients was significantly higher than that in low-risk patients(P < 0.01).
ConclusionsAMI patients have a higher incidence of CIN after emergency PCI.LVEF < 40%, eGFR < mL·min^-1·1.73 m^-2 and contrast dosage >300 mL are the main risk factors.The quantitative nomogram risk model has a good predictive efficacy and is worthy of application.

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