急性髂股静脉血栓形成患者下肢深静脉血栓形成后综合征的影响因素分析  

Influencing factors for lower extremity postthrombotic syndrome in patients with acute iliofemoral vein thrombosis

作　　者：孙亚峰[1] 仇鹏 黄家麒 Sun Yafeng;Qiu Peng;Huang Jiaqi(Department of Chinese Medicine Surgery,the First People's Hospital of Shangqiu City,Shangqiu 476100,China;Department of Vascular Surgery,the Ninth People's Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)

机构地区：[1]河南省商丘市第一人民医院中医外科,商丘476100 [2]上海交通大学医学院附属第九人民医院血管外科,上海200011

出　　处：《中华解剖与临床杂志》2022年第2期110-114,共5页Chinese Journal of Anatomy and Clinics

基　　金：上海交通大学医学院附属第九人民医院临床研究助推项目(JYLI201824)。

摘　　要：目的探讨急性髂股静脉血栓形成患者并发下肢深静脉血栓形成后综合征(PTS)的危险因素及预测模型。方法回顾性研究。纳入上海交通大学医学院附属第九人民医院血管外科2017年1月—2018年6月233例急性髂股静脉血栓形成患者临床资料。其中,男135例、女98例,年龄17~85(58.69±15.73)岁,行腔内治疗200例,行保守治疗33例。采用简单化随机分组,按7∶3比例分为建模组163例和验证组70例。观察指标:(1)随访患者PTS的发生情况;(2)影响PTS发生的危险因素分析;(3)建立PTS风险预测模型。结果(1)患者均获随访,随访时间12~18个月。233例患者中发生PTS 81例(34.80%),其中接受腔内血栓清除术治疗的200名患者中发生PTS 61例(30.50%),保守治疗患者发生PTS 20例(60.60%),两者比较差异有统计学(χ2=11.32,P=0.010)。建模组与验证组患者的年龄、性别、体质量指数(BMI)、深静脉血栓形成(DVT)危险因素、症状与体征的个数、合并疾病、DVT病程史、腔内血栓清除术治疗、PTS等比较,差异均无统计学意义(P值均>0.05)。(2)单因素、多因素分析显示,男性(X1)、BMI(X2)、亚急性及慢性DVT史(X3)、静脉曲张史(X4)、症状与体征个数(X5)、腔内血栓清除术治疗(X6)是急性髂股静脉DVT患者PTS的危险因素(比值比=2.46、1.14、3.44、4.33、1.28、0.24,95%可信区间为1.06~5.67、1.04~1.25、1.38~8.59、1.71~10.97、1.01~1.62、0.08~0.69,P值均<0.05)。(2)根据二元logistic回归分析建立PTS预测模型:logit(P)=-5.075+0.899X1+0.134X2+1.235X3+1.465X4+0.248X5-1.443X6,受试者操作特征曲线下面积为0.81,灵敏度为90%,特异度为65%。结论男性、BMI、亚急性及慢性DVT史、静脉曲张史、症状与体征个数,以及腔内血栓清除术治疗是急性髂股静脉血栓形成患者PTS的危险因素。针对急性髂股静脉血栓形成患者PTS风险建立的预测模型,为DVT患者提供个性化的PTS风险评估,以期更好地指导临床治疗。Objective To explore the predictive model of postthrombotic syndrome(PTS)in patients with iliofemoral vein thrombosis.Methods Retrospective study.The clinical data of 233 patients with acute iliofemoral vein thrombosis admitted to the Department of Vascular Surgery,the Ninth People's Hospital of Shanghai Jiaotong University School of Medicine,from January 2017 to June 2018 were included.Of the patients,135 were males and 98 were females with ages of 17-85(58.69±15.73)years old,and 200 received intracavitary treatment.By using simplified random grouping in accordance with the ratio of 7∶3,the patients were divided into 163 cases in the modeling group and 70 cases in the verification group.The observation indicators were as follows:(1)the occurrence of PTS in patients during follow-up;(2)risk factors affecting the occurrence of PTS;(3)a PTS risk prediction model.Results(1)All patients were followed up for 12-18 months.PTS occurred in 81 cases(34.80%)out of 233 patients.Among the cases of PTS,61(30.50%)occurred in 200 patients who received intracavitary thrombectomy,and 20(60.60%)occurred in patients who did not undergo surgical treatment.A statistical difference was found between the two groups(χ2=11.32,P=0.010).No statistically significant differences in age,gender,body mass index(BMI),deep vein thrombosis(DVT)risk factors,number of symptoms and signs,comorbidity,history of DVT,thrombectomy,PTS,and other metrics were found between the modeling group and the validation group(all P values>0.05).(2)Univariate and multivariate analyses showed that male sex(X1),BMI(Χ2),history of subacute and chronic DVT(X3),history of varicose veins(X4),number of symptoms and signs(X5),and intracavitary thrombosis evacuation treatment(X6)were risk factors for PTS in patients with acute iliofemoral vein DVT(odds ratio=2.46,1.14,3.44,4.33,1.28,and 0.24;95%confidence intervals of 1.06-5.67,1.04-1.25,1.38-8.59,1.71-10.97,1.01-1.62,and 0.08-0.69,all P values<0.05).(2)The PTS prediction model established on the basis of binary logistic

关 键 词：静脉血栓形成 髂股静脉 深静脉血栓形成后综合征 危险因素 风险预测模型 

分 类 号：R543.6[医药卫生—心血管疾病]