基于随机森林算法的急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后无复流风险因素分析

doi:10.3969/j.issn.1006-5253.2021.01.002

摘要
图/表
参考文献
相关文章 (1)

全文: PDF (1436 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的采用随机森林算法探讨急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）术后无复流风险因素。方法回顾性分析2013年1月至2019年6月期间某院行直接PCI术的急性STEMI患者的临床资料。收集患者入院时的一般资料、相关检验指标以及PCI术后情况等。应用随机森林算法和多因素logistic 回归分析对风险因素进行分析。结果收集352例符合纳入标准的行直接PCI术的急性STEMI患者，其中63例无复流，289例有复流。构建随机森林模型，使用Cindex进行评估，训练集C-index为0.980，测试集C-index为0.840，模型预测效力尚可，筛选出变量平均血小板体积/淋巴细胞比率（MPVLR）、病变长度、高血压、发病到球囊扩张时间（PBT）、淋巴细胞计数（LYM）、血小板/淋巴细胞比率（PLR），进一步行多因素logistic回归表明MPVLR、高血压、PBT、LYM、PLR为影响急性STEMI患者直接PCI术后无复流的风险因素。结论通过随机森林分析筛选出了急性STEMI患者直接PCI术后无复流风险因素，结合logistic回归分析，MPVLR、高血压、PBT、LYM、PLR为影响急性STEMI患者直接PCI术后无复流的风险因素，可为医务人员快速简单地进行风险分析、及早干预提供依据。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	俞霄

关键词 ：急性ST段抬高型心肌梗死, 经皮冠状动脉介入治疗, 无复流, 随机森林, logistic回归

Abstract：Objective To investigate the risk factors of no-reflow after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) based on random forest algorithm. Methods A retrospective observational study was carried out in one hospital from January 2013 to June 2019. The general clinical data of the patients, various blood indicators and PCI postoperative conditions were collected. Random forest algorithm and multivariate logistic regression analysis were used to analyze the risk factors. Results We collected 352 STEMI patients who met the inclusion criteria, of which 63 had no reflow and 289 had reflow. We constructed a random forest models, C-index to assess discrimination performance in the training dataset was 0.980 and C-index to assess discrimination performance in the test dataset was 0.840. The variables mean platelet volume to lymphocyte ratio (MPVLR), length of lesion, hypertension, pain-to-balloon time (PBT), lymphocyte count (LYM) and platelet to lymphocyte ratio (PLR) were selected. Multivariate logistic regression further showed that MPVLR, hypertension, PBT, LYM and PLR were independent risk factors affecting no-reflow after PCI in patients with acute STEMI.Conclusion Random forest analysis combined with multivariate logistic regression showed that MPVLR, hypertension, PBT, LYM and PLR were independent risk factors affecting noreflow after PCI in patients with acute STEMI, which could provide a basis for rapid and simple risk analysis and early intervention of medical staff.

Key words： acute ST-segment elevation myocardial infarction percutaneous coronary intervention non-reflow random forest logistic regression

收稿日期: 2020-09-08

通讯作者: 俞霄，Email：yxsxdqrmyy@sina.com

引用本文:

俞霄. 基于随机森林算法的急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后无复流风险因素分析[J]. 中国医院统计, 2021, 28(1): 6-11.
Yu Xiao. Analysis of risk factors for non-reflow after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction based on random forest algorithm. journal1, 2021, 28(1): 6-11.

链接本文:

http://manu58.magtech.com.cn/Jwk_zgyytj/CN/10.3969/j.issn.1006-5253.2021.01.002 或 http://manu58.magtech.com.cn/Jwk_zgyytj/CN/Y2021/V28/I1/6

［1］VOGEL B, CLAESSEN B E, ARNOLD S V, et al. ST-segment elevation myocardial infarction［J］. Nat Rev Dis Primers,2019,5(1):39.
［2］ARMSTRONG P W, GERSHLICK A H, GOLDSTEIN P, et al. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction［J］. N Engl J Med,2013,368(15):1379-1387.
［3］REZKALLA S H, DHARMASHANKAR K C, ABDALRAHMAN I B, et al. No-reflow phenomenon following percutaneous coronary intervention for acute myocardial infarction: Incidence, outcome, and effect of pharmacologic therapy［J］. J Interv Cardiol, 2010, 23(5):429-436.
［4］HARRISON R W, AGGARWAL A, OU F S, et al. Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction［J］. Am J Cardiol, 2013, 111(2):178-184.
［5］岳莉英，李海文，边云飞．MPVLR对急性ST段抬高型心肌梗死患者直接PCI术后无复流的预测价值［J］．中国动脉硬化杂志，2019，27(1)：40-44．
［6］KURTUL A, ACIKGOZ S K. Usefulness of mean platelet volume-to-lymphocyte ratio for predicting angiographic No-reflow and shortterm prognosis after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction［J］. Am J Cardiol, 2017, 120(4):534-541.
［7］KURTUL A, YARLIOGLUES M, MURAT S N, et al. Usefulness of the platelettolymphocyte ratio in predicting angiographic reflow after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction［J］. Am J Cardiol, 2014, 114(3):342-347.
［8］GELBARD R B, HENSMAN H, SCHOBEL S, et al. Random forest modeling can predict infectious complications following trauma laparotomy［J］. J Trauma Acute Care Surg, 2019, 87(5):1125-1132.
［9］TOTH R, SCHIFFMANN H, HUBE-MAGG C, et al. Random forest-based modelling to detect biomarkers for prostate cancer progression［J］. Clin Epigenetics, 2019, 11(1):148.
［10］颜红兵，傅向华，李春洁，等．ST段抬高型急性心肌梗死院前溶栓治疗中国专家共识［J］．中国介入心脏病学杂志，2018，26(4)：181-190．
［11］李少辉，王海昌，张英梅，等．血小板与淋巴细胞比率对急性ST段抬高型心肌梗死患者PCI术后无复流的预测价值［J］．现代生物医学进展，2016，16(17)：3268-3271．
［12］亢爱春，李阳，季汉华，等．中性粒细胞淋巴细胞比值与急性ST段抬高型心肌梗死患者PCI术后无复流相关性研究［J］．中国循证心血管医学杂志，2020，12(1)：103-106．
［13］方厚民，杨锋，李建荣，等．中性粒细胞淋巴细胞比值与急性ST段抬高型心肌梗死患者PCI术后无复流相关性研究［J］．现代医院，2018，18(9)：1308-1310．

［14］吴洪洲，陈博，刘强．MPV 与 NSTEMI、STEMI患者梗死相关动脉分布的关系［J］．山东医药，2015，55(22)：49-50．
［15］何宝强．MPV联合PDW预测急性STEMI患者行PCI术后的短期及远期预后［D］．乌鲁木齐：新疆医科大学，2018．
［16］MAY A E, LANGER H, SEIZER P, et al. Platelet-leukocyte interactions in inflammation and atherothrombosis［J］. Semin Thromb Hemost, 2007, 33(2):123-127．
［17］沈群弟．基于医院的高血压患者颈动脉硬化发生风险列线图的建立［J］．中国医院统计，2020，27(3)：211-214．