| 摘要: |
| 目的筛选危险因素,建立老年风湿性心脏病(RHVD)患者瓣膜手术前冠心病危险度预测模型,以指导冠脉造影检查的选择。方法基于1998~2009年我院连续585例患者的资料,通过Logistic回归筛选老年RHVD患者瓣膜手术前冠心病的危险因素,建立危险度预测模型并以bootstrap方法优化,以预测概率P＜0.05为低危险度。以接受者操作特性曲线(ROC曲线)比较该模型和国外类似模型的诊断效能。结果老年RHVD患者并发冠心病的危险因素中影响突出的是：男性、年龄、心绞痛、高血压、高胆固醇血症。成功建立危险度预测 |
| 关键词: 风湿性心脏病 冠心病 心脏外科手术 危险因素 Logistic模型 |
| DOI：10.3724/SP.J.1008.2011.0706 |
| 投稿时间：2010-12-29修订日期：2011-04-23 |
| 基金项目:卫生部卫生行业科研专项“心脏瓣膜病规范化外科治疗的研究”(项目编号200802096) |
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| A prediction model for coronary artery diseases in elder patients undergoing operations for rheumatic heart valve disease: establishment and assessment |
| LI Shu-chun1,LIAO Xue-wen1,LI Li1,ZHANG Luo-man2,XU Zhi-yun1* |
| (1. Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;2. Center for Clinical Epidemiology and Evidence-based Medicine, Second Military Medical University, Shanghai 200433, China) |
| Abstract: |
| Objectives: To predict the CAD in patients undergoing operation for mitral valve regurgitation, some logistic regression models have been established for the patients suffered from degenerative valve disease. In patients with rheumatic heart valve disease(RHVD), the risk of coexistent CAD is low and therefore the models might not be applicable for prediction. In this article, we sought to develop a logistic model that estimates the risk of significant CAD in elder patients undergoing operations for RHVD.
Methods: A total of 585 elder patients who underwent routine coronary angiography before heart valve operations for RHVD between 1998 and 2009 were analyzed. A bootstrap logistic regression model on the basis of clinical risk factors was developed to identify low-risk (＜5%) patients. Receiver operating characteristic (ROC) curves were used to compare discrimination.
Results: Independent predictors of coronary artery disease include age, male sex, angina, hypertension, and hypercholesterolemia. According to the logistic model, 155 patients were designated as low risk. Of these patients, only 4 (2.6%) had single-vessel disease, and none had multivessel disease. The model showed better discrimination than those established ones, with an area under the ROC curve of 0.793.
Conclusion: Our model can reliably estimate the prevalence of significant CAD in elder patients before heart valve operations for RHVD. Low-risk patients can be identified in whom routine preoperative angiography may be safely avoided. |
| Key words: rheumatic heart valve disease, coronary artery disease, risk factor, logistic regression model |
