【摘要】 目的研究动脉瘤性蛛网膜下腔出血(ASAH)并发心肌损伤的危险因素,建立风险预测列线图模型。方法回顾性分析126例ASAH患者的临床资料,采用单因素分析和多因素Logistic回归分析筛选ASAH患者发生心肌损伤的独立危险因素;并基于筛选得到的危险因素构建风险列线图预测模型,行Bootstrap法对模型进行验证,检验模型的精确性及预测性。结果年龄> 60岁(OR=3.939,95%CI:1.171～13.253)、ASAH疾病严重程度(OR=3.425,95%CI:1.506～7.785)、动脉瘤Ⅲ-Ⅴ级(OR=2.921,95%CI:1.092～7.814)、FisherⅢ-Ⅳ级(OR=2.467,95%CI:0.894～6.809)及Hunt-HessⅢ-Ⅴ级(OR=2.401,95%CI:0.924～6.237)是ASAH患者并发心肌损伤的独立危险因素(P <0.05～0.01)。基于以上独立危险因素建立的预测并发心肌损伤风险列线图模型的预测能力较好。用Bootstrap内部验证法验证预测ASAH并发心肌损伤的风险列线图模型,C-index指数为0.821(95%CI:0.799～0.844),表明列线图模型的精准度和区分度较好。结论对ASAH患者的年龄、疾病严重程度、动脉瘤分级、Fisher分级、Hunt-Hess分级等因素进行综合分析,可预测ASAH患者发生心肌损伤的风险,进而采用相应干预措施可改善患者的预后,具有较高的临床价值。更多还原

【Abstract】 Objective To study the risk factors of aneurysmal subarachnoid hemorrhage( ASAH) complicated with myocardial injury,and to establish a risk prediction nomogram model.Methods The clinical data of 126 patients with ASAH were analyzed retrospectively. Univariate analysis and multivariate Logistic regression analysis were used to screen the independent risk factors of myocardial injury in patients with ASAH. Based on the screened risk factors,the risk nomogram prediction model was constructed,and the bootstrap method was used to verify the model to test the accuracy and predictability of the model. Results Age > 60 years( OR = 3. 939,95% CI: 1. 171-13. 253),severity of ASAH disease( OR = 3. 425,95% CI: 1. 506-7. 785),aneurysm grade Ⅲ-Ⅴ( OR = 2. 921,95% CI: 1. 092-7. 814),Fisher grade Ⅲ-Ⅴ( OR = 2. 467,95% CI: 0. 894-6. 809) and hunt Hess grade Ⅲ-Ⅴ( OR = 2. 401,95% CI: 0. 894-6. 809,95% CI: 0. 924-6. 237) was an independent risk factor for myocardial injury in patients with ASAH( P < 0. 05-0. 01). The nomogram model based on the above independent risk factors had good predictive ability. Bootstrap internal validation method was used to verify the risk nomogram model of ASAH complicated with myocardial injury. The c-index index was 0. 821( 95% CI: 0. 799-0. 844),indicating that the accuracy and discrimination of the nomogram model were good. Conclusion Comprehensive analysis of the age,disease severity,aneurysm grade,Fisher grade,Hunt-Hess grade and other factors of patients with ASAH can predict the risk of myocardial injury in patients with ASAH,and the corresponding intervention measures can improve the prognosis of patients,which has high clinical value.更多还原