心房颤动患者射频消融术中首剂肝素ACT预测模型构建
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南京医科大学第一附属医院心血管内科

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江苏省人民医院临床能力提升工程护理项目(JSPH-NB-2022-2);江苏省人民医院国家自然基金青年基金培育计划(PY 2022002);南京大学中国医院改革发展研究院课题(NDYG052)


Prediction model of ACT for the first dose of heparin in patients with atrial fibrillation during radiofrequency ablation
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Jiangsu Provincial People’s Hospital Clinical Competence Enhancement Nursing Project (JSPH-NB-2022-2) ;Jiangsu Provincial People’s Hospital National Natural Science Foundation Young Investigator Cultivation Program (PY 2022002) ;Nanjing University China Hospital Reform and Development Research Institute Project (NDYG052)

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    摘要:

    目的:建立并验证心房颤动患者射频消融术中给予首剂肝素30min后测得活化凝血时间(activated clotting time,ACT)的列线图预测模型。方法:采用单中心、回顾性研究设计。选择2020年1月至2022年12月于南京医科大学第一附属医院心内科导管室行导管射频消融治疗、非瓣膜性心房颤动患者1090例,以3:1比例随机分为训练集和测试集,对两组各项指标进行Kruskal-Wallis检验、卡方检验比较其基线特征。通过LASSO 回归及单因素、多因素线性回归分析影响30min-ACT 的因素,据此建立心房颤动患者射频消融术中30min-ACT的预测模型并评估其预测效果。结果:多因素结果分析提示卒中史、华法林、血小板计数、凝血酶原时间、基础ACT、基础ACT2、首剂肝素剂量是房颤患者射频消融术中首剂肝素ACT的独立预测因素,据此构建的列线图预测模型预测具有一定的准确度(训练集=65.9%,测试集=74.6%)和较高的灵敏度(训练集=77.4%,测试集=83%)。结论:根据卒中史、华法林、血小板计数、凝血酶原时间、基础ACT、基础ACT2、首剂肝素剂量构建的列线图模型可以预测心房颤动患者射频消融术中首剂肝素的抗凝效果——30min-ACT,对临床工作具有一定指导作用。

    Abstract:

    Objective: To establish and verify the prediction model of activated clotting time (ACT) measured 30 minutes after the first dose of heparin in patients with atrial fibrillation during radiofrequency ablation. Methods: A single-center retrospective study design was adopted. From January 2020 to December 2022, 1090 patients with nonvalvular atrial fibrillation were selected for radiofrequency cardiac catheter ablation with the catheter room of the Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University. Patients were randomly divided into the training set and testing set in a 3:1 ratio. Kruskal-Wallis test and Chi-square test were used to compare baseline characteristics of the training set and testing set. LASSO regression, univariate and multivariate linear regression were used to analyze the independent factors influencing 30min-ACT. Based on this, the prediction model of 30min-ACT with the first dose of heparin during radiofrequency ablation in patients with atrial fibrillation was established and its predictive effect was evaluated. Results: Multivariate analysis of results suggested that stroke history, warfarin, platelet count, prothrombin time, basal ACT, basal ACT2, and first dose of heparin were independent predictors of first dose of heparin ACT during radiofrequency cardiac ablation in patients with atrial fibrillation, and the prediction model based on the constructed histogram had a certain accuracy (training set = 65.9%, testing set = 74.6%) and higher sensitivity (training set = 77.4%, testing set = 83%). Conclusion: Based on stroke history, warfarin, platelet count, PT, baseline ACT, baseline ACT2 and first dose of heparin, the nomogram model can predict the anticoagulant effect of the first dose of heparin in atrial fibrillation patients, 30min-ACT, providing valuable clinical guidance.

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  • 收稿日期:2024-09-20
  • 最后修改日期:2024-11-23
  • 录用日期:2024-11-27
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