预测老年髋部骨折深静脉血栓风险的列线图模型构建  

Construction of Nomogram Model for Predicting the Risk of Deep Vein Thrombosis in Elderly Patients with Hip Fracture

作　　者：胡钢[1] 李刚[1] 殷铭[1] 汪志炯[1] 刘勇[1] 俞云飞[1] HU Gang;LI Gang;YIN Ming;WANG Zhijiong;LIU Yong;YU Yunfei(Wuxi Hospital of Traditional Chinese Medicine,Wuxi 214000,Jiangsu China)

机构地区：[1]江苏无锡市中医医院,江苏无锡214000

出　　处：《中国中医骨伤科杂志》2021年第6期26-31,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：无锡市卫计委青年项目(Q201651)。

摘　　要：目的:分析老年髋部骨折患者DVT形成风险的独立危险因素,构建预测老年髋部骨折患者DVT形成风险的列线图模型。方法:收集2016年1月至2019年12月住院治疗的224例老年髋部骨折患者的临床资料,根据彩色多普勒超声检查结果,将其分为DVT组及非DVT组,采用单因素分析及多因素Logistic回归分析,找出老年髋部骨折患者DVT形成的独立危险因素;应用R Studio构建评估老年髋部骨折患者DVT形成风险的列线图模型,并验证其准确性。结果:单因素及多因素Logistic回归分析结果显示糖尿病(OR=4.635,95%CI为1.272~16.898)、卧床时间(OR=1.313,95%CI为1.144~1.507)、D-D(OR=1.317,95%CI为1.118~1.550)是老年髋部骨折患者DVT形成的独立危险因素(P<0.05);对列线图模型进行检验,ROC曲线图显示该评估模型AUC为0.920(95%CI为0.869~0.971);校准曲线为斜率接近于1的直线,Hosmer-Lemeshow拟合优度检验显示该模型评估老年髋部骨折患者DVT形成风险具有良好准确度(χ2=6.933,P=0.544)。结论:糖尿病、卧床时间、D-D是老年髋部骨折患者DVT形成的独立危险因素,以此构建的预测老年髋部骨折患者DVT形成风险的列线图模型,具有良好的诊断效能及准确度,可为临床预测老年髋部骨折患者DVT形成风险提供科学指导。Objective:To analyze the independent risk factors of deep vein thrombosis(DVT)in elderly patients with hip fracture,and to build a nomogram model to predict the risk of DVT formation in elderly hip fracture patients.Methods:The clinical data of 224 elderly patients with hip fracture admitted to hospital from January 2016 to December 2019 were collected.The patients were divided into DVT group and non-DVT group by color doppler ultrasonography.Univariate analysis and multivariate logistic regression analysis were used to analyze the independent risk factors of deep vein thrombosis in elderly patients with hip fracture.A nomogram was constructed by R Studio to predict the risk of DVT and validated its accuracy.Results:Univariate analysis and multivariate logistic regression analysis revealed that that diabetes(OR=4.635,95%CI:1.272 to 16.898),bed time(OR=1.313,95%CI:1.144 to 1.507)and D-D(OR=1.317,95%CI:1.118 to 1.550)were independent risk factors of deep vein thrombosis in elderly patients with hip fracture(P<0.05).For validating the nomogram,ROC curve revealed that the nomogram’s AUC was 0.920(95%CI:0.869 to 0.971),the slope of the calibration plot was close to 1.Hosmer-Lemeshow goodness of fit test showed that the model had good accuracy in assessing the risk of DVT formation in elderly hip fracture patients(χ2=6.933,P=0.544).Conclusion:The study reveals that diabetes,bed time and D-D are independent risk factors of deep vein thrombosis in elderly patients with hip fracture.The nomogram which is constructed based on these independent risk factors has good diagnostic and accuracy.The nomogram can be used to guide clinical prediction.

关 键 词：老年 髋部骨折 深静脉血栓 回归分析 列线图 

分 类 号：R683.42[医药卫生—骨科学]