| 血清前白蛋白联合SinoSCORE对心脏瓣膜置换术的预测价值 |
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| 引用本文： | 王金帅,杨思远.血清前白蛋白联合SinoSCORE对心脏瓣膜置换术的预测价值[J].心脏杂志,2020,32(4):379-384. |
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| 作者姓名： | 王金帅 杨思远 |
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| 作者单位： | 1.贵州省铜仁市人民医院胸心外科，贵州 铜仁 554300 |
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| 摘 要： | 目的 评价血清前白蛋白（prealbumin,PA）联合SinoSCORE模型对心瓣膜置换术的补充预测价值。 方法 收集贵州医科大学附属医院心脏外科2017年7月~2019年8月415例心脏瓣膜置换术患者的围手术期资料，根据患者术前血清PA水平将患者分为低PA组（PA<200 mg/L）和正常PA组（PA≥200 mg/L），比较两组患者的实际病死率及SinoSCORE对两组患者的预测病死率有无统计学差异。应用logistic回归分析评价血清PA与术后死亡的关联性，通过计算受试者工作特征曲线下面积(AUC)、净重新分类指数（NRI）和整体鉴别指数（IDI）来综合评价PA的补充预测价值。 结果 低PA组患者的病死率显著高于正常PA组患者（P<0.01），术后30 d病死率（包括自动出院后死亡）分别为13.2%和4.6%，SinoSCORE对两组患者的预测病死率无统计学差异。单因素logistic回归分析结果示PA水平与术后死亡负关联（OR=0.989，P<0.01）。SinoSCORE联合PA后ROC曲线下面积（AUC）增加0.091，与SinoSCORE单独预测病死率的ROC曲线下面积（AUC）比较有显著的统计学差异（P<0.01）。SinoSCORE联合PA后的净重新分类指数（NRI）和整体鉴别指数（IDI）为0.092和0.023。 结论 血清PA在SinoSCORE模型预测心脏瓣膜置换术的死亡风险中有较好的补充预测价值。因此，在今后建立新的心脏瓣膜手术风险评分模型时可将血清PA作为重要的预测因子纳入到模型中。
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| 关 键 词： | 血清前白蛋白 SinoSCORE 心脏瓣膜置换术 |
| 收稿时间： | 2020-04-02 |
Predictive value of serum prealbumin combined with SinoSCORE for patients undergoing heart valve replacement |
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| Affiliation: | 1.Department of Thoracic and Cardiovascular Surgery, Tongren People’s Hospital, Tongren 554300, Guizhou, China2.Department of Cardiovascular Surgery, First Affiliated Hospital, Guizhou Medical University, Guiyang 550001, Guizhou, China |
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| Abstract: | AIM To evaluate the supplementary predictive value of serum prealbumin combined with SinoSCORE model for heart valve replacement. METHODS Perioperative data of 415 patients undergoing heart valve replacement at our department from July 2017 to August 2019 were retrospectively analyzed. The patients were divided into two groups based on their preoperative serum prealbumin levels (PA<200 mg/L and PA≥200 mg/L), Actual mortality rate and predicted mortality rate of the two groups were compared. The association between serum prealbumin and postoperative death was examined by logistic regression analysis and the supplementary predictive value of prealbumin was comprehensively evaluated by calculating the area under the receiver operating characteristic curve (AUC), the net reclassification index (NRI) and the integrated discrimination index (IDI). RESULTS The mortality rate of patients in the reduced prealbumin group was significantly higher than that in normal prealbumin group (P<0.01), the 30-day postoperative mortality (including death after against advice discharge from hospital) was 13.20% and 4.63%, respectively. No statistically significant difference between the two groups was found in the predicted mortality of SinoSCORE . Univariate logistic regression analysis showed negative correlation between prealbumin levels and postoperative death (OR=0.989, P<0.01). Area under the ROC curve (AUC) of SinoSCORE combined with prealbumin increased by 0.091, and there was significant statistical difference in predicting mortality compared with the area under the ROC curve (AUC) of SinoSCORE alone (P<0.01). Net reclassification index (NRI) and integrated discrimination index (IDI) of SinoSCORE combined with prealbumin were 0.092 and 0.023. CONCLUSION Serum prealbumin has a good supplementary predictive value for SinoSCORE model in predicting the risk of death in patients undergoing heart valve replacement. Therefore, serum prealbumin can be included as an important predictor in the new heart valve surgery risk scoring model established in the future. |
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