Page 101 - 南京医科大学自然版

第44卷第12期 南京医科大学学报（自然科学版）
2024年12月 Journal of Nanjing Medical University（Natural Sciences） ·1715 ·

·临床研究·

心房颤动患者射频消融术中首剂肝素ACT预测模型构建

冯 婕，鲍志鹏，周丽华，赵雅凡，宋 雯，周 燕，陈思彤，渠 强，何 英 *
南京医科大学第一附属医院心内科，江苏 南京 210029

［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 30 min 后测得活化凝血时间（activated clotting time，
ACT）（30 min⁃ACT）的列线图预测模型。方法：选择2020年1月—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1 090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⁃Wal⁃
lis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30 min⁃ACT的因素，据此建立心房
颤动患者射频消融术中30 min⁃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ACT 、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
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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83.0%）。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ACT 、首剂肝素剂量构建的30 min⁃ACT列线图模型可以预测心房
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颤动患者射频消融术中首剂肝素的抗凝效果，对临床工作具有一定指导作用。
［关键词］ 心房颤动；射频消融术；肝素抗凝；首剂肝素ACT；预测模型
［中图分类号］ R541.75 ［文献标志码］ A ［文章编号］ 1007⁃4368（2024）12⁃1715⁃08
doi：10.7655/NYDXBNSN241000

Construction of a predictive model of ACT for the first dose of heparin in patients with

atrial fibrillation during radiofrequency ablation
FENG Jie，BAO Zhipeng，ZHOU Lihua，ZHAO Yafan，SONG Wen，ZHOU Yan，CHEN Sitong，QU Qiang，HE Ying *
Department of Cardiology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

［Abstract］ Objective： To establish and validate a nomogram prediction model for the activated clotting time（ACT）measured 30
minutes after the first dose of heparin（30 min⁃ACT）in patients with atrial fibrillation undergoing radiofrequency ablation. Methods：
From January 2020 to December 2022，1 090 patients with non ⁃ valvular atrial fibrillation who underwent catheter radiofrequency
ablationinthe catheter room of the Department of Cardiology，the First Affiliated Hospital of Nanjing Medical University were included.
These patients were randomly divided into a training set and a testing set in a 3∶1 ratio. Kruskal⁃Wallis and Chi⁃square tests were used
to compare the baseline characteristics of the two groups. LASSO regression and univariate and multivariate linear regression analyses
were conductedto identify factors influencing 30 min⁃ACT. Based on these findings，a prediction model for 30 min⁃ACT with the first
dose of heparin during radiofrequency ablation in patients with atrial fibrillation was established and evaluated. Results：Multivariate
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analysis suggested that stroke history，warfarin use，platelet count，prothrombin time（PT），baseline ACT，baseline ACT ，and first dose
of heparin were independent predictors of first dose of heparin ACT during radiofrequency cardiac ablation in patients with atrial
fibrillation. The resulting nomogram prediction model showed a certain level of accuracy（training set 65.9%，testing set 74.6%）and
higher sensitivity（training set 77.4%，testing set 83.0%）. Conclusion：The 30 min⁃ACT nomogram model，based on stroke history，
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warfarin ues，platelet count，PT，baseline ACT，baseline ACT ，and first dose of heparin，can predict the anticoagulant effect of the first
dose of heparin in atrial fibrillation patients，providing valuable clinical guidance.
［Key words］ atrial fibrillation；radiofrequency ablation；heparin anticoagulation；first dose of heparin ACT；predictive models
［J Nanjing Med Univ，2024，44（12）：1715⁃1722］

［基金项目］ 江苏省人民医院临床能力提升工程（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）
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通信作者（Corresponding author），E⁃mail： 1726089233@qq.com