2020 年第 2 期 第 15 卷

急性冠状动脉综合征患者血清维生素D水平与不良预后的相关性及Nomogram预后模型构建

Relation between serum vitamin D level and poor prognosis in patients with acute coronary syndrome and the construction of Nomogram prognostic model

作者：寇立臣刘建军王志斌刘皓

英文作者：

单位：中国人民解放军联勤保障部队第九四○医院重症医学科，兰州730050

英文单位：

关键词：急性冠状动脉综合征；维生素D；经皮冠状动脉介入；Nomogram模型

英文关键词：

• 摘要：

• 【摘要】目的    探讨经皮冠状动脉介入（PCI）治疗的急性冠状动脉综合征（ACS）患者血清维生素D水平与主要不良心脑血管事件（MACCE）风险的相关性，并根据维生素D水平构建预测MACCE发生风险的Nomogram模型。方法    收集2016年1月至2018年1月中国人民解放军联勤保障部队第九四○医院收治的138例经PCI治疗的ACS住院患者临床资料，包括一般资料、血清25-羟基维生素D［25-(OH)D］水平等实验室检查结果，以及术后6个月MACCE发生情况。采用单因素和多因素Logistic回归模型分析MACCE发生的危险因素。根据独立危险因素构建Nomogram模型。结果    138例患者中，25-(OH)D水平正常72例（52.2%），不足28例（20.3%），缺乏38例（27.5%）。术后6个月内发生MACCE者42例，发生率为30.4%。MACCE组患者的25-(OH)D水平明显低于非MACCE组患者［（14±8）μg/L比（24±9）μg/L］,差异有统计学意义（P＜0.001）。多因素Logistic回归分析结果显示年龄＞73岁（比值比＝7.627）、糖尿病（比值比＝2.888）、高血压（比值比＝3.246），25-(OH)D缺乏（比值比＝4.367）是MACCE发生的独立危险因素（均P＜0.05）。Nomogram模型一致性指数为0.724，该模型的实际曲线与理想曲线的吻合度较好。结论    25-(OH)D缺乏是ACS患者PCI术后MACCE的独立危险因素。根据维生素D水平构建的Nomogram模型可预测PCI术后MACCE发生的风险，但该模型的预测价值需要进一步研究证实。

• 【Abstract】Objective    To analyze the relation between serum vitamin D level and major adverse cardio-cerebrovascular events(MACCE) in patients with acute coronary syndrome(ACS) undergoing percutaneous coronary intervention(PCI), and to construct a Nomogram model for prediction of MACCE. Methods    Clinical data, serum 25-hydroxyvitamin D［25-(OH)D］ level and other laboratory results were collected in 138 ACS patients who underwent PCI in the 940th Hospital of Toint Logistics Support Force of the Chinese People′s Liberation Army from January 2016 to January 2018. Risk factors of MACCE in 6 months after PCI were analyzed by univariate and multivariate logistic regression. Nomogram prognostic model for MACCE was constructed according to the independent risk factors. Results    Among the 138 patients, 72 patients(52.2%) had normal 25-(OH)D level, 28 patients(20.3%) had shortage of 25-(OH)D and 38 patients(27.5%) had deficiency of 25-(OH)D. The 6-month incidence of MACCE was 30.4%(n＝42). Level of serum 25-(OH)D in MACCE patients was significantly lower than that in non-MACCE patients［（14±8）μg/L vs （24±9）μg/L］(P＜0.001). Multivariate logistic regression showed that age＞73 years(odds ratio＝7.627), diabetes(odds ratio＝2.888), hypertension(odds ratio＝3.246) and deficiency of 25-(OH)D(odds ratio＝4.367) were independent risk factors of MACCE(all P＜0.05). C-index of Nomogram model was 0.724, suggesting that the actual curve of the model was coincident with the ideal curve. Conclusions    25-(OH)D deficiency is an independent risk factor of MACCE in ACS patients undergoing PCI. Nomogram model based on vitamin D level can provide prognostic value for MACCE after PCI.