【摘要】 目的 探讨老年ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）术后缺血再灌注损伤（IRI）的危险因素，构建列线图模型并验证其预测性能。方法 回顾性选取2022年1月至2024年12月南通大学附属如皋医院收治的366例老年急性STEMI患者作为研究对象，收集患者临床资料，根据PCI术后是否发生IRI将其分为IRI组（187例）和非IRI组（179例）。比较两组临床资料；采用LASSO回归分析筛选关键变量后进行多因素Logistic回归分析；基于多因素回归分析结果构建列线图模型，并验证其预测性能。结果 本研究患者术后IRI发生率为51.09%（187/366）。LASSO回归分析基于λ_min从29个候选变量中筛选出19个关键变量为自变量纳入多因素Logistic回归分析，结果显示，高血压、冠状动脉左前降支梗死、肢体近端血管闭塞、C反应蛋白、白细胞计数、脑钠肽、总胆固醇水平均为老年STEMI患者PCI术后IRI的独立危险因素。受试者工作特征曲线分析结果显示，列线图模型预测PCI术后IRI的曲线下面积为0.882（95%CI:0.847～0.916）,Hosmer-Lemeshow检验χ²=8.575（P=0.379）。决策曲线分析和累积发生率曲线分析结果显示，在高风险阈值0～1范围内，采用该模型预测PCI术后IRI例数高于实际发生IRI的例数，且利用该模型进行干预可获得正向收益。结论 基于LASSO回归分析构建出一套用于预测老年STEMI行PCI术后IRI的列线图模型，经验证预测性能良好，可为临床IRI的早期识别与治疗方案制定提供参考。更多还原

【Abstract】 Objective To investigate the risk factors for ischemia-reperfusion injury（IRI） in elderly patients with STsegment elevation myocardial infarction（STEMI） after percutaneous coronary intervention（PCI）, construct a nomogram model, and validate its predictive performance. Methods A total of 366 elderly patients with acute STEMI admitted to Rugao Hospital Affiliated to Nantong University from January 2022 to December 2024 were retrospectively enrolled as the research subjects. Clinical data of patients were collected, and they were divided into the IRI group（187 cases） and the non-IRI group（179 cases） according to the occurrence of IRI after PCI. The clinical data of the two groups were compared, and LASSO regression analysis was used to screen key variables for multivariate logistic regression analysis. Based on the results of multivariate analysis, a nomogram model was constructed and its predictive performance was verified. Results The incidence of postoperative IRI in this study was 51.09%（187/366）. LASSO regression analysis, based on λ_min, selected 19 key variables from 29 candidate variables as independent variables for multivariate logistic regression analysis. The results showed that hypertension, left anterior descending coronary artery infarction, proximal limb vascular occlusion, C-reactive protein, white blood cell count, brain natriuretic peptide, and total cholesterol were independent risk factors for IRI in elderly STEMI patients after PCI. Receiver operating characteristic curve analysis showed that the area under the curve of the nomogram model for predicting IRI after PCI was 0.882（95%CI: 0.847–0.916）. The Hosmer-Lemeshow test yielded a χ² value of 8.575（P=0.379）. Decision curve analysis and cumulative incidence curve analysis showed that within the high-risk threshold range of 0 to 1, the number of IRI cases predicted by the model was higher than the actual number of IRI cases, and intervention using this model could yield positive net benefits. Conclusion This study constructed a nomogram model based on LASSO regression analysis for predicting IRI after PCI in elderly STEMI patients. The model was validated to have good predictive performance and can provide a reference for early clinical identification of IRI and formulation of treatment strategies.更多还原