本文選題：慢性心力衰竭 + 冠心病�。� 參考：《大連醫(yī)科大學》2017年碩士論文

【摘要】：目的:研究慢性心衰合并冠心病患者經皮冠狀動脈介入治療(Percutaneous Coronary Intervention,PCI)有效性的預測因素的預測價值方法:(一)前瞻性研究:依據(jù)心衰診斷標準和入排標準納入慢性心衰患者,首先給予優(yōu)化的指南指導的藥物治療(GDMT)。篩選出同時具備以下4條的患者:(1)a.年齡在75歲以下.b不合并糖尿病.c有心絞痛及等同癥狀.d體表心電圖無病理性Q波-即預測因素陽性(2)a.年齡在75歲以上.b合并糖尿病.c無心絞痛及等同癥狀.d體表心電圖有病理性Q波-即預測因素陰性。實施PCI治療并隨訪至1年,依據(jù)第12個月的隨訪結果和PCI治療有效性標準將患者分為有效組和無效組。同時具備四條因素的患者即預測因素陽性,共有29例,其中21例PCI有效,8例無效,計算陽性預測值(Positive predictive value,PPV)。預測因素陰性者共有24例,其中20例無效,4例有效,計算陰性預測值(negative predictive value,NPV)。除去失訪和數(shù)據(jù)不全面者,最終納入的100例患者中,PCI有效組44例,預測因素陽性的患者中PCI有效的是21例,預測因素陰性的患者中PCI有效的是4例,計算靈敏度(Sensitivity,Se)。100例患者中,PCI無效組56例,預測因素陽性的患者中PCI無效的是8例,預測因素陰性的患者中PCI無效的是20例,計算特異度(Specificity,Sp)。(二)回顧性研究:對課題組前期的105例患者進行篩選,篩選標準同前瞻性研究。預測因素陽性的共有30例,其中25例PCI有效,5例無效,計算PPV。預測因素陰性的共有32例,其中28例無效,4例有效,計算NPV。105例患者中,PCI有效組36例,預測因素陽性的患者中PCI有效的是25例,預測因素陰性的患者中PCI有效的是4例,計算Se。PCI無效組69例,預測因素陽性的患者中PCI無效的是5例,預測因素陰性的患者中PCI無效的是28例,計算Sp。(三)兩組合并:在205例患者中預測因素陽性的共有59例,其中46例PCI有效,13例無效,計算PPV。預測因素陰性的共有56例,其中48例無效,8例有效,計算NPV。205例患者中,PCI有效組80例,預測因素陽性的患者中PCI有效的是46例,預測因素陰性的患者中PCI有效的是8例,計算Se。PCI無效組125例,預測因素陽性的患者中PCI無效的是13例,預測因素陰性的患者中PCI無效的是48例,計算Sp。(四)分層分析:前瞻性研究中共納入100例患者,對年齡、糖尿病、心絞痛及等同癥狀、病理性Q波四項預測因素進行具體分層分析,計算陽性預測值及陰性預測值。并計算不同時符合四項預測因素的陽性及陰性預測值。結果:(一)前瞻性研究:(1)100例患者中PCI有效組44例,PCI無效組56例。基線資料見表1。(2)100例患者中預測因素陽性的共有29例,其中21例PCI有效,8例無效;預測因素陰性的共有24例,其中20例PCI無效,4例有效。Se是84%,PPV是72.4%,Sp是71.4%,NPV為83.3%。見表2。(二)回顧性研究:(1)前期105例患者中PCI有效組36例,PCI無效組69例。(2)預測因素陽性的共有30例,其中25例PCI有效,5例無效;預測因素陰性的共有32例,其中28例PCI無效,4例有效。Se為86.2%,PPV是83.3%,Sp為84.8%,NPV為87.5%。見表3。(三)兩組合并(1)205例患者中PCI有效組80例,PCI無效組125例�；�資料見表4。(2)205例患者中預測因素陽性的共有59例,其中46例PCI有效,13例無效;預測因素陰性的共有56例,其中48例PCI無效,8例有效。Se為85.2%,PPV是77.9%,Sp為78.7%,NPV為85.7%。見表5。(四)分層分析年齡小于75歲、不合并糖尿病、有心絞痛及等同癥狀、無病理性O波的陽性預測值分別為76.6%、41.2%、70.4%、31.0%;年齡大于75歲、合并糖尿病、無心絞痛及等同癥狀、有病理性Q波的陰性預測值分別為:84.9%、53.1%、86.9%、46.6%。當患者年齡小于75歲、有心絞痛及等同癥狀時,其陽性預測值為60.9%;當患者年齡大于75歲、無心絞痛及等同癥狀時,其陰性預測值為72.5%。當患者年齡在75歲以下、有心絞痛及等同癥狀、不合并糖尿病時,其陽性預測值為65.7%;當患者年齡大于75歲、無心絞痛及等同癥狀、合并糖尿病時,其陰性預測值為75%。見表6-11結論:(1)75歲以下、不合并糖尿病、術前有心絞痛及等同癥狀、體表心電圖無病理性Q波的患者行PCI治療陽性預測值約為77.9%(2)75歲以上、合并糖尿病、術前無心絞痛及等同癥狀、體表心電圖有病理性Q波的患者行PCI治療陰性預測值約為85.7%(3)不同時具備四項預測因素的陽性預測值范圍為54.8%-65.7%;陰性預測值范圍為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%
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4;R541.6

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