急性心肌梗死PCI术后健康行为模式的潜在类别分析及与预后的关系

doi:10.3760/cma.j.cn441417-20250228-21029

摘要/Abstract

摘要： 目的　分析急性心肌梗死（AMI）患者经皮冠状动脉介入（PCI）术后健康行为模式的潜在类别，探讨其与预后的关系。方法　选取2023年1月至2024年5月在南阳医学高等专科学校第一附属医院心血管内科行PCI治疗的AMI患者173例进行前瞻性队列研究，其中男116例，女57例；年龄（59.82±8.04）岁；Killip心功能分级Ⅰ～Ⅱ级134例，Ⅲ级39例。采用问卷调查患者一般资料和健康行为。采用潜在类别模型分析AMI患者PCI术后健康行为模式的潜在类别，比较不同健康行为模式潜在类别AMI患者临床资料，并分析PCI术后预后影响因素。计数资料采用χ²检验、logistic回归分析、潜在类别分析。结果　问卷有效回收率为97.69%（169/173）。AMI患者PCI术后健康行为模式在2个潜在类别时模型的拟合效果最优（分类精准性指数=0.80，罗梦戴尔鲁本校正似然比检验P=0.003，Bootstrap似然比检验P<0.001），将此2个潜在类别分别命名为“控制较差组”和“控制良好组”。控制较差组初中及以下文化程度、家庭居住地为农村、Killip心功能分级Ⅲ级占比高于控制良好组（χ²=6.018、4.431、7.814，均P<0.05）。经logistic回归分析证实，年龄≥60岁［比值比（OR）=2.472，95%置信区间（95%CI）：1.252～4.879］、Killip心功能分级Ⅲ级（OR=2.670，95%CI：1.440～4.950）、控制较差健康行为模式（OR=2.113，95%CI：1.185～0.376）均是AMI患者PCI术后预后不良的危险因素（均P<0.05）。结论　AMI患者PCI术后健康行为模式有控制较差、控制良好2个潜在类别，可能与患者的文化程度、家庭居住地、心功能相关，是预后不良的影响因素。

关键词: 急性心肌梗死, 经皮冠状动脉介入, 健康行为模式, 预后, 潜在类别分析

Abstract: Objective　To analyze the latent classes of health behavior patterns in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI), and to explore their relationship with prognosis. Methods　A prospective cohort study was conducted on 173 patients with AMI who underwent PCI at Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanyang Medical College from January 2023 to May 2024, including 116 males and 57 females who were (59.82 ± 8.04) years old. Among them, 134 cases were classified as Killip heart function grades Ⅰ-Ⅱ, and 39 cases grade Ⅲ. A questionnaire survey was conducted to investigate their general information and health behaviors. The latent classes of health behavior patterns in the patients were analyzed using the latent class model, and the clinical data of the patients with different latent classes of health behavior patterns were compared. The factors affecting the prognosis after PCI were analyzed. χ² test, logistic regression analysis, and latent class analysis were used for the statistical analysis. Results　The effective recovery rate of the questionnaires was 97.69% (169/173). The fitting effect of the model on the health behavior patterns of the patients was optimal in two latent classes (the classification accuracy index = 0.80; the Rommel and Ruben corrected likelihood ratio test P=0.003; the Bootstrap likelihood ratio test P<0.001), which were named as a poorly controlled group and a well controlled group, respectively. The proportions of the patients with a junior high school education level or below, rural family residence, and Killip heart function grade Ⅲ in the poorly controlled group were higher than those in the well controlled group (χ²=6.018, 4.431, and 7.814; all P<0.05). The logistic regression analysis confirmed that age ≥ 60 years [odds ratio (OR) =2.472, 95% confidence interval (95%CI) 1.252-4.879], Killip heart function grading Ⅲ (OR=2.670, 95%CI 1.440-4.950), and poor control of health behavior patterns (OR=2.113, 95%CI 1.185-0.376) were all risk factors for poor prognosis in the patients (all P<0.05). Conclusion　The health behavior patterns of patients with AMI after PCI have two latent classes, namely poorly controlled and well controlled, which may be related to the patient's education level, family residence, and heart function, and these are the factors affecting poor prognosis.

Key words: Acute myocardial infarction, Percutaneous coronary intervention, Health behavior patterns, Prognosis, Latent class analysis

宋歌张彩丽. 急性心肌梗死PCI术后健康行为模式的潜在类别分析及与预后的关系[J]. 国际医药卫生导报, 2025, 31(21): 3666-3671.

Song Ge, Zhang Caili. Latent class analysis of health behavior patterns after PCI for acute myocardial infarction and its relationship with prognosis[J]. International Medicine and Health Guidance News, 2025, 31(21): 3666-3671.

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