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    冠心病PCI术后病人MACE风险感知预测模型构建及对健康生活行为的影响

    Construction of a risk perception prediction model for MACE in patients after PCI and its impact on healthy lifestyle behaviors

      摘要
    • 摘要:
      目的： 分析冠心病（CHD）经皮冠状动脉介入（PCI）术后病人主要心血管不良事件（MACE）风险感知的影响因素并构建列线图预测模型，探讨MACE风险感知与健康生活行为的关系。
      方法： 选择行PCI术的CHD病人168例为研究对象，根据出院后MACE风险感知水平分为高水平组和低水平组，分析低MACE风险感知的主要影响因素，构建列线图模型并进行验证预测效果，比较2组健康生活行为的差异性。
      结果： 文化程度、术后服药种类、植入支架个数、疾病自我管理能力得分、家庭亲密度和适应性得分和患者沟通模式得分是PCI术后病人MACE风险感知的主要影响因素（P ＜ 0.05 ~ P ＜ 0.01）。Hosmer–Lemeshow检验χ2 = 6.36，P = 0.61，提示预测值与实际值一致性较高，ROC曲线下面积为0.900（95%CI：0.851～0.948，P ＜ 0.01），灵敏度83.9%，特异度85.7%，提示列线图模型预测价值良好。低水平组病人在PCI术后健康生活行为量表6？？？个维度得分及总分均低于高水平组（P ＜ 0.05 ~ P ＜ 0.01）。
      结论： 文化程度低、服药种类偏少、植入单个支架、疾病自我管理能力偏弱、家庭亲密度和适应性偏差、不善于沟通交流的PCI术后病人MACE风险感知偏低，构建的列线图模型预测效果良好，医护人员应制定并实施针对性干预方案提高MACE风险感知水平，从而维持术后健康生活行为，降低MACE发生率。

       

      Abstract:
      Objective To analyze the influencing factors of risk perception of major cardiovascular adverse events (MACE) in coronary heart disease (CHD) patients treated with percutaneous coronary intervention (PCI), and construct a nomogram prediction model to explore the relationship between MACE risk perception and healthy lifestyle behaviors.
      Methods A total of 168 patients with CHD who underwent PCI were selected as the research subjects. According to the patients' perception of the risk of MACE after discharge, they were divided into the high-risk group and the low-risk group. The main influencing factors of low MACE risk perception were analyzed, a nomogram model was constructed, its predictive effect was verified, and the differences in healthy lifestyle behaviors between two groups were compared.
      Results The educational level, types of postoperative medication, number of implanted stents, scores for disease self-management ability, scores for family intimacy and adaptability and scores for patient communication mode were the main influencing factors of MACE risk perception in patients after PCI (P ＜ 0.05 to P ＜ 0.01). The Hosmer-Lemeshow test (χ2 = 6.36, P = 0.61) indicated a high consistency between the predicted values and the actual values. The area under the ROC curve was 0.900 (95%CI: 0.851–0.948, P ＜ 0.001), with a sensitivity of 83.9%, a specificity of 85.7%. These results showed that the nomogram model had good predictive value. The scores of the six dimensions and total score of the health lifestyle behavior scale in the low-level group were all lower than those in high-level group after PCI (P ＜ 0.05 to P ＜ 0.01).
      Conclusions After PCI, the patients with low educational level, fewer types of medications, single stent implantation, weak disease self-management ability, deviations in family intimacy and adaptability and poor communication skills have a lower perception of MACE risk. The constructed nomogram model has a good predictive effect. Medical staff should formulate and implement targeted intervention plans to improve the perception of MACE risk, thereby maintaining healthy postoperative behaviors and reducing the incidence of MACE.

       

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