麻醉安全与质控2025，Vol.7Issue(5)：369-375,7.DOI:10.3969/j.issn.2096-2681.2025.05.002
糖尿病患者非心脏手术术后心肌损伤的危险因素分析及预测模型构建
Risk factors and prediction model construction for myocardial injury after non-cardiac surgery in diabetic patients
摘要
Abstract
Objective To investigate risk factors for postoperative myocardial injury in diabetic patients and construct a predictive model for myocardial injury after non-cardiac surgery(MINS)in diabetic patients through the integration of coronary computed tomography angiography(CCTA)anatomical features and perioperative clinical indicators.Methods A retrospective analysis was conducted on 242 diabetic patients who underwent non-cardiac surgery and preoperative CCTA within six months at Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 1st to September 30th,2023.Patients were classified into MINS group(n=54)and non-MINS group(n=188),according to whether MINS occurs.LASSO regression and multivariable logistic regression were used to identify risk factors for postoperative myocardial injury in diabetic patients,followed by nomogram construction.Results LASSO regression identified left anterior descending lesions,diuretic dosage,number of diseased vessels,coronary stent history,anemia,total cholesterol,and systolic blood pressure as key predictors.Multivariable logistic regression confirmed left anterior descending lesions(OR=2.49,95%CI 1.24-5.04,P=0.011),coronary stent history,diuretic dosage,systolic blood pressure,and anemia as independent risk factors.The nomogram demonstrated good discrimination(AUC=0.778,95%CI 0.709-0.847;sensitivity=0.702,specificity=0.686)and internal validation consistency(mean bootstrapped AUC=0.765,95%CI 0.738-0.782).Hosmer-Lemeshow test indicated adequate calibration(χ2=11.416,P=0.179).Decision curve analysis(DCA)revealed superior net benefit within a threshold probability range from 0.1 to 0.9.Conclusion Left anterior descending lesions are predictive of MINS in diabetic patients.The integrated model combining perioperative factors effectively stratifies MINS risk in diabetic patients.关键词
冠状动脉CT血管造影/非心脏手术术后心肌损伤/糖尿病/危险因素/预测模型Key words
coronary CT angiography/myocardial injury after non-cardiac surgery/diabetes mellitus/risk factors/predictive models引用本文复制引用
丁睿达,吕蒙,王栋,王月兰..糖尿病患者非心脏手术术后心肌损伤的危险因素分析及预测模型构建[J].麻醉安全与质控,2025,7(5):369-375,7.基金项目
山东第一医科大学学术提升计划(2019QL015) （2019QL015）
山东省自然科学基金青年项目(ZR2021QH194) （ZR2021QH194）
