老年冠心病患者PCI术后肺部感染危险因素及其模型构建Risk factors for postoperative pulmonary infection in elderly coronary heart disease patients undergoing PCI and establishment of model
吴黎明;李娜;罗珊;赵彩杰;王建辉;
摘要(Abstract):
目的 探讨老年冠心病(CHD)患者经皮冠状动脉介入(PCI)术后肺部感染的危险因素及其模型构建。方法 根据术后是否发生肺部感染将2020年1月-2022年1月于唐山市工人医院行PCI术的250例CHD老年患者分为感染组30例和未感染组220例。分析两组患者临床资料及实验室检查结果,单因素及多因素Logistic回归分析老年CHD患者PCI术后肺部感染的危险因素。构建Logistic回归模型,通过绘制受试者工作特征(ROC)曲线评估模型对老年CHD患者PCI术后肺部感染的预测价值。结果 多因素Logistic回归分析结果显示,年龄大、外周血CD_4+水平低、有吸烟史、有侵入性操作、外周血血红蛋白(Hb)水平<90 g/L是老年CHD患者PCI术后肺部感染的独立危险因素(P<0.05)。构建的回归方程模型为logit(P)=-9.875+年龄×1.324+外周血CD_4+水平低、有吸烟史、有侵入性操作、外周血血红蛋白(Hb)水平<90 g/L是老年CHD患者PCI术后肺部感染的独立危险因素(P<0.05)。构建的回归方程模型为logit(P)=-9.875+年龄×1.324+外周血CD_4+水平×1.232+吸烟史×1.045+侵入性操作×1.345+外周血Hb水平×0.983。ROC曲线分析显示,当logit(P)>12.050时,模型预测老年CHD患者PCI术后肺部感染诊断敏感度为80.00%,特异度为74.09%。结论 年龄大、外周血CD_4+水平×1.232+吸烟史×1.045+侵入性操作×1.345+外周血Hb水平×0.983。ROC曲线分析显示,当logit(P)>12.050时,模型预测老年CHD患者PCI术后肺部感染诊断敏感度为80.00%,特异度为74.09%。结论 年龄大、外周血CD_4+水平低、有吸烟史、有侵入性操作、外周血Hb水平<90 g/L是老年CHD患者PCI术后肺部感染的危险因素,Logistic回归模型对其预测价值较高,临床可针对以上情况的患者采取相应治疗及干预措施,以降低肺部感染的风险。
关键词(KeyWords): 冠心病;老年;经皮冠状动脉介入术;术后感染;肺部感染;危险因素;回归模型
基金项目(Foundation): 河北省社会科学基金项目(HB19SH001)
作者(Authors): 吴黎明;李娜;罗珊;赵彩杰;王建辉;
参考文献(References):
- [1] Cybulska B,Kiosiewicz-Latoszek L.Landmark studies in coronary heart disease epidemiology.The Framingham Heart Study after 70 years and the Seven Countries Study after 60 years[J].Kardiol Pol,2019,77(2):173-180.
- [2] Wu HC,Chiou JC.Potential benefits of probiotics and prebiotics for coronary heart disease and stroke[J].Nutrients,2021,13(8):2878.
- [3] Azzalini L,Karmpaliotis D,Santiago R,et al.Contemporary issues in chronic total occlusion percutaneous coronary intervention[J].JACC Cardiovasc Interv,2022,15(1):1-21.
- [4] Zimbardo G,Cialdella P,DI Giusto F,et al.Physiological assessment after percutaneous coronary intervention:the hard truth[J].Panminerva Med,2021,63(4):519-528.
- [5] Tarantini G,Zuccarelli V.Percutaneous coronary intervention versus coronary artery bypass graft surgery:the battle Rages on[J].Catheter Cardiovasc Interv,2021,98(3):434-435.
- [6] Ejheisheh MA,Correa-Rodriguez M,Fernández-Aparicio A,et al.Prior percutaneous coronary intervention is associated with low health-related quality of life after coronary artery bypass graft[J].Nurs Health Sci,2020,22(4):1022-1029.
- [7] 国际心脏病学会和协会、世界卫生组织临床命名标准化联合专题组.缺血性心脏病的命名及诊断标准[J].中华心血管病杂志,1981,9(1):75-76.
- [8] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
- [9] Wang NJ,Sun Y,Zhang HJ,et al.Long-term night shift work is associated with the risk of atrial fibrillation and coronary heart disease[J].Eur Heart J,2021,42(40):4180-4188.
- [10] Nichols S,McGregor G,Breckon J,et al.Current insights into exercise-based cardiac rehabilitation in patients with coronary heart disease and chronic heart failure[J].Int J Sports Med,2021,42(1):19-26.
- [11] Tokgozoglu L,Kocyigit D.Achieving post-percutaneous coronary intervention low-density lipoprotein-cholesterol goals:science versus reality[J].Eur J Prev Cardiol,2021,28(8):852-853.
- [12] 吕烨辉,郑淑梅,王海荣,等.老年经皮冠状动脉介入术后肺部感染预后影响因素[J].中华医院感染学杂志,2020,30(21):3277-3282.
- [13] 熊慧,张鹏,潘群,等.老年冠心病PCI术后肺部感染影响因素及血CD4+T淋巴细胞水平[J].中华医院感染学杂志,2020,30(22):3457-3461.
- [14] Aidoud A,Marlet J,Angoulvant D,et al.Influenza vaccination as a novel means of preventing coronary heart disease:effectiveness in older adults[J].Vaccine,2020,38(32):4944-4955.
- [15] 诸帆,胡申江.老年冠心病合并心衰患者医院肺部感染病原学特点与危险因素研究[J].中国预防医学杂志,2020,21(7):749-753.
- [16] 郑运周,侯天文,张会峰,等.老年冠心病合并肺部感染患者病原学特点及危险因素分析[J].解放军医药杂志,2021,33(8):70-73.
- [17] Koziei P,Jankowski P,Kosior DA,et al.Smoking cessation in patients with established coronary artery disease:data from the POLASPIRE survey[J].Kardiol Pol,2021,79(4):418-425.
- [18] 陆洪涛,王联发,李华.冠心病冠状动脉病变程度和病变程度加重的影响因素分析[J].心血管康复医学杂志,2019,28(3):298-301.
- [19] 张蕾,陈捷,陈玉婷.冠心病合并肺部感染患者Ghrelin/obestatin变化及意义[J].临床和实验医学杂志,2017,16(4):333-335.
- [20] Kosyakovsky LB,Austin PC,Ross HJ,et al.Early invasive coronary angiography and acute ischaemic heart failure outcomes[J].Eur Heart J,2021,42(36):3756-3766.
- [21] 周青,叶俊,傅京力,等.肺结核并发肺部感染的危险因素分析[J].传染病信息,2020,33(6):546-548.
- [22] Preub D,Garcia G,Laule M,et al.Myocardial CT perfusion imaging for the detection of obstructive coronary artery disease:multisegment reconstruction does not improve diagnostic performance[J].Eur Radiol Exp,2022,6(1):5.
- [23] 冯治宇,谭守勇,章志俊,等.营养支持对伴营养不良的肺结核并肺部感染者的疗效观察[J].临床肺科杂志,2018,23(7):1169-1171.
- [24] 谭守勇,梁卓智,黎燕琼.继发肺部感染对耐多药结核病患者转归的影响[J].中国防痨杂志,2017,39(5):442-444.
- [25] 马佳慧,孙宇佳,高莹莹.不同年龄段老年肺部感染患者营养状态分析[J].长春中医药大学学报,2020,36(3):577-579.