慢性心衰合并冠心病患者PCI术有效性预测因素的预测价值研究

发布时间：2018-05-27 22:34

本文选题：慢性心力衰竭 + 冠心病　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:研究慢性心衰合并冠心病患者经皮冠状动脉介入治疗(Percutaneous Coronary Intervention,PCI)有效性的预测因素的预测价值方法:(一)前瞻性研究:依据心衰诊断标准和入排标准纳入慢性心衰患者,首先给予优化的指南指导的药物治疗(GDMT)。筛选出同时具备以下4条的患者:(1)a.年龄在75岁以下.b不合并糖尿病.c有心绞痛及等同症状.d体表心电图无病理性Q波-即预测因素阳性(2)a.年龄在75岁以上.b合并糖尿病.c无心绞痛及等同症状.d体表心电图有病理性Q波-即预测因素阴性。实施PCI治疗并随访至1年,依据第12个月的随访结果和PCI治疗有效性标准将患者分为有效组和无效组。同时具备四条因素的患者即预测因素阳性,共有29例,其中21例PCI有效,8例无效,计算阳性预测值(Positive predictive value,PPV)。预测因素阴性者共有24例,其中20例无效,4例有效,计算阴性预测值(negative predictive value,NPV)。除去失访和数据不全面者,最终纳入的100例患者中,PCI有效组44例,预测因素阳性的患者中PCI有效的是21例,预测因素阴性的患者中PCI有效的是4例,计算灵敏度(Sensitivity,Se)。100例患者中,PCI无效组56例,预测因素阳性的患者中PCI无效的是8例,预测因素阴性的患者中PCI无效的是20例,计算特异度(Specificity,Sp)。(二)回顾性研究:对课题组前期的105例患者进行筛选,筛选标准同前瞻性研究。预测因素阳性的共有30例,其中25例PCI有效,5例无效,计算PPV。预测因素阴性的共有32例,其中28例无效,4例有效,计算NPV。105例患者中,PCI有效组36例,预测因素阳性的患者中PCI有效的是25例,预测因素阴性的患者中PCI有效的是4例,计算Se。PCI无效组69例,预测因素阳性的患者中PCI无效的是5例,预测因素阴性的患者中PCI无效的是28例,计算Sp。(三)两组合并:在205例患者中预测因素阳性的共有59例,其中46例PCI有效,13例无效,计算PPV。预测因素阴性的共有56例,其中48例无效,8例有效,计算NPV。205例患者中,PCI有效组80例,预测因素阳性的患者中PCI有效的是46例,预测因素阴性的患者中PCI有效的是8例,计算Se。PCI无效组125例,预测因素阳性的患者中PCI无效的是13例,预测因素阴性的患者中PCI无效的是48例,计算Sp。(四)分层分析:前瞻性研究中共纳入100例患者,对年龄、糖尿病、心绞痛及等同症状、病理性Q波四项预测因素进行具体分层分析,计算阳性预测值及阴性预测值。并计算不同时符合四项预测因素的阳性及阴性预测值。结果:(一)前瞻性研究:(1)100例患者中PCI有效组44例,PCI无效组56例。基线资料见表1。(2)100例患者中预测因素阳性的共有29例,其中21例PCI有效,8例无效;预测因素阴性的共有24例,其中20例PCI无效,4例有效。Se是84%,PPV是72.4%,Sp是71.4%,NPV为83.3%。见表2。(二)回顾性研究:(1)前期105例患者中PCI有效组36例,PCI无效组69例。(2)预测因素阳性的共有30例,其中25例PCI有效,5例无效;预测因素阴性的共有32例,其中28例PCI无效,4例有效。Se为86.2%,PPV是83.3%,Sp为84.8%,NPV为87.5%。见表3。(三)两组合并(1)205例患者中PCI有效组80例,PCI无效组125例。基线资料见表4。(2)205例患者中预测因素阳性的共有59例,其中46例PCI有效,13例无效;预测因素阴性的共有56例,其中48例PCI无效,8例有效。Se为85.2%,PPV是77.9%,Sp为78.7%,NPV为85.7%。见表5。(四)分层分析年龄小于75岁、不合并糖尿病、有心绞痛及等同症状、无病理性O波的阳性预测值分别为76.6%、41.2%、70.4%、31.0%;年龄大于75岁、合并糖尿病、无心绞痛及等同症状、有病理性Q波的阴性预测值分别为:84.9%、53.1%、86.9%、46.6%。当患者年龄小于75岁、有心绞痛及等同症状时,其阳性预测值为60.9%;当患者年龄大于75岁、无心绞痛及等同症状时,其阴性预测值为72.5%。当患者年龄在75岁以下、有心绞痛及等同症状、不合并糖尿病时,其阳性预测值为65.7%;当患者年龄大于75岁、无心绞痛及等同症状、合并糖尿病时,其阴性预测值为75%。见表6-11结论:(1)75岁以下、不合并糖尿病、术前有心绞痛及等同症状、体表心电图无病理性Q波的患者行PCI治疗阳性预测值约为77.9%(2)75岁以上、合并糖尿病、术前无心绞痛及等同症状、体表心电图有病理性Q波的患者行PCI治疗阴性预测值约为85.7%(3)不同时具备四项预测因素的阳性预测值范围为54.8%-65.7%;阴性预测值范围为67.8%-75%
[Abstract]:Objective: To study the predictive value of the predictive factors for the effectiveness of Percutaneous Coronary Intervention (PCI) in patients with chronic heart failure and coronary heart disease: (I) prospective study: according to the criteria for the diagnosis of heart failure and the criteria for entry into the patients with chronic heart failure, the first to give optimal guidance for the drug treatment (GDM T) patients with the following 4 items: (1) the age of A. under 75 years of age.B without diabetes.C angina and equivalent symptom.D body surface electrocardiogram no pathological Q wave - that is, predictive factor positive (2) A. age above 75 years of age.B combined with diabetes.C non angina and symptomatic.D body surface electrocardiogram with pathological Q wave - that is, predictive factor negative The patients were followed up to 1 years and were followed up to 1 years. The patients were divided into effective and ineffective groups based on twelfth months' follow-up results and PCI treatment effectiveness criteria. There were four factors in patients with positive predictive factors and 29 cases, of which 21 cases were PCI effective, 8 cases were ineffective, and the positive predictive values (Positive predictive value, PPV). Predictive factors were negative. There were 24 cases, of which 20 were ineffective, 4 were effective, negative predictive value, NPV. In the 100 patients who were eventually included in the final inclusion, 44 cases were effective in PCI, and 21 of the patients with positive predictive factors were effective in 21. 4 cases of PCI were effective in pretested factors negative (Se). Nsitivity, Se) of.100 patients, 56 cases of PCI ineffective, 8 cases of PCI ineffective in predictive factor positive patients, 20 cases of PCI ineffective in predictive factor negative patients, calculated specificity (Specificity, Sp). (two) retrospective study of 105 patients in the early stage of the group, screening standard and prospective study. Positive predictive factors. Positive predictive factors were positive. There were 30 cases, of which 25 cases were PCI effective, 5 cases were null and void, 32 cases were negative in calculating the predictive factors of PPV., of which 28 cases were invalid, 4 cases were valid, 36 cases of PCI effective group were calculated in NPV.105 cases, and 25 cases of PCI were effective in the positive predictive factors. The effective of the predictive factor negative patients were 4 cases, 69 cases of Se.PCI null group were calculated, and 69 cases were predicted. Among the patients with positive factors, PCI was ineffective in 5 cases. Among the patients with negative predictive factors, PCI was ineffective in 28 cases, and Sp. (three) two were combined: 59 cases were positive in 205 patients, of which 46 cases were PCI effective, 13 were invalid, and the PPV. predictive factors were negative in 56 cases, 48 cases were ineffective, 8 cases were effective, and NPV.205 cases were calculated. Among the 80 cases of PCI effective group, 46 cases were effective in the positive predictive factors. In the patients with negative predictive factors, 8 cases were effective in 8 cases, 125 cases of Se.PCI ineffective group, 13 cases of PCI ineffective in the predictive factor positive patients, 48 cases with negative predictive factor PCI, and Sp. (four) stratified analysis: prospective study. The Chinese Communist Party included 100 patients with four predictors of age, diabetes, angina and equivalent symptoms, and pathological Q waves, calculated positive predictive values and negative predictive values, and calculated the positive and negative predictive values of four predictors. Results: (a) prospective study: (1) 44 cases of effective group of 100 patients in 100 cases. There were 56 cases of PCI ineffective group. The baseline data were shown in table 1. (2) 100 patients with positive predictive factors in 29 cases, of which 21 cases were PCI effective and 8 cases were invalid; there were 24 cases with negative predictive factors, 20 were PCI invalid, 4 cases of effective.Se were 84%, PPV was 72.4%, Sp was 71.4%, NPV was 83.3%.. For example, there were 69 cases of PCI ineffective group. (2) there were 30 cases of positive predictive factors, of which 25 cases were PCI effective, 5 cases were invalid, 32 cases with negative predictive factors, 28 cases PCI ineffective, 4 cases of effective.Se 86.2%, PPV 83.3%, Sp, NPV as 87.5%., PCI effective group, PCI invalid group. 4. (2) of the 205 patients with positive predictive factors were 59, of which 46 were PCI effective and 13 were ineffective; 56 were negative in predictive factors, 48 of which were invalid, 8 in effective.Se, 85.2%, PPV in 77.9%, Sp for 78.7%, and NPV for 85.7%., which was younger than the age, without diabetes, angina and equivalent symptoms, and no pathology. The positive predictive values of O waves were 76.6%, 41.2%, 70.4%, 31%, aged more than 75 years old, with diabetes, no angina and equivalent symptoms. The negative predictive values of pathological Q waves were 84.9%, 53.1%, 86.9%, and 46.6%. when the patient was younger than 75, angina and other symptoms, the positive predictive value was 60.9%; when the patient was older than 75 years of age, When there was no angina and equivalent symptoms, the negative predictive value was 72.5%. when the patient was under 75 years of age, angina and equivalent symptoms, and the positive predictive value was 65.7% without diabetes. When the patient was older than 75, without angina and equivalent symptoms, the negative predictive value of the patients was 75%. and (1) under 75 years of age, (1) under 75 years of age, Patients with diabetes, preoperative angina and equivalent symptoms, the positive predictive value of PCI treatment with no pathological Q wave on the body surface electrocardiogram were about 77.9% (2) over 75 years old, with diabetes, preoperative unangina and equivalent symptoms, and the negative predictive value of PCI treatment for patients with pathological Q wave on the body surface electrocardiogram was about 85.7% (3) and four items were not available at the same time. The positive predictive value of the factors was 54.8%-65.7%, and the negative predictive value was 67.8%-75%
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4;R541.6

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