急性冠状动脉综合征患者PCI后心脏康复依从性的影响因素分析及列线图预测模型构建

doi:10.3969/j.issn.1007-3205.2025.06.008

摘要/Abstract

摘要： 目的探究急性冠状动脉综合征（acute coronary syndrome，ACS）患者经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）后心脏康复依从性影响因素，并基于此构建其列线图预测模型。
方法选取2020年6月—2022年8月我院收治的PCI术后于康复急性期进行心脏康复的ACS患者250例，根据心脏康复依从性将ACS患者分为依从性良好组（154例）和依从性差组（96例）。收集2组一般资料并采用人口学资料调查表、抑郁量表、焦虑量表对患者进行调查；采用多因素Logistic回归分析ACS患者PCI后心脏康复依从性的影响因素，并通过Spearman相关性检验分析这些影响因素与依从性之间的关系；基于影响ACS患者PCI后心脏康复依从性的因素构建列线图预测模型；利用受试者工作特征曲线（receiver operating characteristic，ROC）、校准曲线以及决策曲线分析，对模型的预测能力、准确性、临床实用性进行评估与验证。
结果与依从性良好组相比，依从性差组患者年龄、文化程度（初中及以下）占比、月收入水平、看病路程、高血压占比、高脂血症占比、对疾病感知情况（差）占比、社会支持情况（差）占比以及抑郁占比、焦虑占比、心功能分级（Ⅲ级）占比显著升高（P＜0.05），血清高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C）、左心室射血分数（left ventricular ejection fraction，LVEF）水平显著降低（P＜0.05）；而在性别、吸烟史、饮酒史、体重指数（body mass index，BMI）、ACS类型、婚姻状况、糖尿病、肾脏疾病、总胆固醇（total cholesterol，TC）、三酰甘油（triglycerides，TG）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-C）、白蛋白（albumin，ALB）、糖化血红蛋白（glycated hemoglobin，HbA1c）、尿酸（uric acid，UA）、左心室舒张末期内径（left ventricular end-diastolic diameter，LVEDD）、左心室收缩末期内径（left ventricular end-systolic diameter，LVESD）、药物种类、术后并发症（脑出血、血栓形成、感染）等方面差异均无统计学意义（P＞0.05）。多因素Logistic回归分析结果显示，年龄、看病路程、抑郁均是影响患者心脏康复依从性的独立危险因素（P＜0.05），文化程度、月收入水平、HDL-C、LVEF水平是患者心脏康复依从性的独立保护因素（P＜0.05）。Spearman相关性分析结果显示，文化程度、月收入水平、HDL-C、LVEF与患者心脏康复依从性评分呈显著正相关（r=0.655、0.720、0.694、0.826，均P＜0.05），年龄、看病路程与患者心脏康复依从性评分呈显著负相关（r=-0.643、-0.812，均P＜0.05），抑郁与患者心脏康复依从性评分之间无明显相关性（r=-0.322，P＞0.05）。列线图预测模型中，ROC曲线模型的AUC=0.970，校准曲线和决策曲线显示该模型具有良好的准确性。
结论年龄、文化程度、月收入水平、看病路程、抑郁、HDL-C、LVEF均是ACS患者PCI后心脏康复依从性的影响因素，基于此建立的列线图预测模型可有效评估患者心脏康复依从性的风险。

关键词: 急性冠状动脉综合征, 经皮冠状动脉介入治疗, 心脏康复依从性

Abstract: Objective To investigate the factors influencing cardiac rehabilitation compliance after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) and to construct a nomogram prediction model based on this.
Methods Two hundred and fifty ACS patients admitted to our hospital from June 2020 to August 2022 who underwent cardiac rehabilitation in the acute phase of rehabilitation after PCI were selected, and the ACS patients were divided into good compliance group (n=154) and poor compliance group (n=96) according to cardiac rehabilitation compliance. The general data of the patients in the two groups were collected and surveyed using the demographic data questionnaire, depression scale, and anxiety scale. The influencing factors of post-PCI cardiac rehabilitation compliance in ACS patients were analyzed using multivariate logistic regression, and the relationship between these influencing factors and compliance was analyzed by the Spearman′s correlation test, and a nomogram was constructed based on the factors influencing the post-PCI cardiac rehabilitation compliance in ACS patients. The predictive ability, accuracy, and clinical utility of the model were evaluated and validated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis.
Results Compared with the good compliance group, the patients in the poor compliance group had significantly higher (P＜0.05) age, percentage of education (junior high school and below), monthly income level, distance traveled to see the doctor, percentage of hypertension, percentage of hyperlipidemia, percentage of (poor) perception of disease, percentage of (poor) social support, as well as percentage of depression, anxiety, and cardiac function class (grade Ⅲ) (P＜0.05), and significantly lower levels of serum high-density lipoprotein cholesterol (HDL-C) and left ventricular ejection fraction (LVEF) levels (P＜0.05); however, the levels of gender, smoking history, alcohol consumption history, body mass index (BMI), ACS type, marital status, diabetes mellitus, renal disease, total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C),albumin (ALB), glycated hemoglobin (HbA1c), uric acid (UA), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), type of medication, and postoperative complications (cerebral hemorrhage, thrombosis, and infections) were not statistically significant (P＞0.05). The results of multivariate logistic regression analysis showed that age, distance traveled to see the doctor, and depression were independent risk factors affecting cardiac rehabilitation compliance of patients (P＜0.05), while education level, monthly income level, HDL-C, and LVEF level were independent protective factors for cardiac rehabilitation compliance of patients (P＜0.05).The results of Spearman′s correlation analysis showed that education level and monthly income levels, HDL-C, and LVEF were significantly and positively correlated with patients′ cardiac rehabilitation compliance scores (r=0.655, 0.720, 0.694, 0.826, all P＜0.05), while age and distance traveled to see a doctor were significantly and negatively correlated with patients′ cardiac rehabilitation compliance scores (r=-0.643, -0.812, both P＜0.05), and there was no significant correlation between depression and patients′ cardiac rehabilitation compliance scores (r=-0.322, P＞0.05). In the nomogram prediction model, the ROC curve model had an area under the ROC curve (AUC)=0.970, and the calibration and decision curves showed that the model had good accuracy.
Conclusion Age, education level, monthly income level, distance traveled to see the doctor, depression, HDL-C, and LVEF are all influencing factors of cardiac rehabilitation compliance after PCI in patients with ACS, and a nomogram prediction model based on this can effectively assess the risk of cardiac rehabilitation compliance in patients.

Key words: acute coronary syndrome, percutaneous coronary intervention, cardiac rehabilitation compliance

方钱超, 吴秋爽, 杜然, 尹洪涛, 滕腾, 丁海杰. 急性冠状动脉综合征患者PCI后心脏康复依从性的影响因素分析及列线图预测模型构建[J]. 河北医科大学学报, 2025, 46(6): 668-675.

FANG Qian-chao, WU Qiu-shuang, DU Ran, YIN Hong-tao, TENG Teng, DING Hai-jie. Analysis of factors influencing cardiac rehabilitation compliance after PCI in patients with acute coronary syndrome and construction of a nomogram prediction model[J]. Journal of Hebei Medical University, 2025, 46(6): 668-675.

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急性冠状动脉综合征患者PCI后心脏康复依从性的影响因素分析及列线图预测模型构建

Analysis of factors influencing cardiac rehabilitation compliance after PCI in patients with acute coronary syndrome and construction of a nomogram prediction model

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