风险评估模型预测人工肝治疗肝衰竭患者发生静脉血栓栓塞症的价值分析  

Value of a risk assessment model in predicting venous thromboembolism in patients with liver failure after artificial liver support therapy

作　　者：陆素芳[1] 黄睿[1] 赵红利 王丹丹[1] 丁玉珍[1] 周红[1] LU Sufang;HUANG Rui;ZHAO Hongli;WANG Dandan;DING Yuzhen;ZHOU Hong(Department of Infectious Diseases,Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院感染性疾病科,南京210008

出　　处：《临床肝胆病杂志》2023年第3期613-619,共7页Journal of Clinical Hepatology

基　　金：国家自然科学基金青年基金项目(81702011);南京大学现代医院管理与发展研究所课题项目&南京鼓楼医院医学发展医疗救助基金(NDYG2021016)。

摘　　要：目的探讨风险评估模型对人工肝治疗肝衰竭患者静脉血栓栓塞症(VTE)发生风险的预测价值。方法回顾性选取2018年3月—2021年12月于南京大学医学院附属鼓楼医院行人工肝治疗的肝衰竭患者184例,其中并发VTE组患者41例,未并发VTE患者(对照组)143例。比较两组患者临床资料,并采用Caprini风险评估模型对两组患者进行评分及风险分级。计量资料两组间比较采用t检验;计数资料两组间比较采用χ^(2)检验;等级资料两组间比较采用Mann-Whitney U秩和检验。采用Logistic回归分析人工肝治疗肝衰竭患者发生VTE的独立危险因素。采用受试者工作特征曲线(ROC曲线)分析Caprini量表评分、多因素预测模型及二者联合对VTE的预测价值。结果并发VTE组患者Caprini量表评分为(4.39±1.10)分,明显高于对照组(3.12±1.04)分(t=6.805,P<0.001)。两组患者Caprini量表危险度分级存在明显差异(Z=-4.872,P<0.001),并发VTE的患者中,高危、极高危组占比更高。单因素分析结果显示,并发VTE组与对照组患者在年龄(t=6.400,P<0.001)、置管方式(χ^(2)=14.413,P<0.001)、人工肝治疗次数(Z=-4.720,P<0.001)、活动情况(Z=-6.282,P<0.001)、合并感染(χ^(2)=33.071,P<0.001)、D-二聚体(t=8.746,P<0.001)、28 d死亡率(χ^(2)=5.524,P=0.022)比较差异均有统计学意义。多因素分析结果显示,人工肝治疗次数(X1)(OR=0.251,95%CI:0.111~0.566,P=0.001)、活动情况(X2)(OR=0.122,95%CI:0.056~0.264,P<0.001)、D-二聚体(X3)(OR=2.921,95%CI:1.114~7.662,P=0.029)为影响肝衰竭人工肝治疗患者VTE发生的独立危险因素。个体预测概率方程为P=1/[1+e(-(7.425-1.384X1-2.103X2+1.072X3))]。ROC曲线分析结果显示,Caprini评分曲线下面积为0.802(95%CI:0.721~0.882,P<0.001),多因素模型曲线下面积为0.768(95%CI:0.685~0.851,P<0.001),二者联合运用曲线下面积为0.957(95%CI:0.930~0.984,P<0.001)。结论Caprini风险评估模型对人工肝治疗肝衰竭患者VTE发生风险具�Objective To investigate the value of a risk assessment model in predicting venous thromboembolism(VTE)in patients with liver failure after artificial liver support therapy.Methods A retrospective analysis was performed for the clinical data of 124 patients with liver failure who received artificial liver support therapy in Affiliated Drum Tower Hospital of Nanjing University Medical School from March 2019 to December 2021,among whom there were 41 patients with VTE(observation group)and 143 patients without VTE(control group).Related clinical data were compared between the two groups,and the Caprini risk assessment model was used for scoring and risk classification of the patients in both groups.The t-test was used for comparison of continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups;the Mann-Whitney U rank sum test was used for comparison of ranked data between two groups.The logistic regression analysis was used to investigate the independent risk factors for VTE in patients with liver failure after artificial liver support therapy.The receiver operating characteristic(ROC)curve was used to investigate the value of Caprini score and the multivariate predictive model used alone or in combination in predicting VTE.Results The observation group had a significantly higher Caprini score than the control group(4.39±1.10 vs 3.12±1.04,t=6.805,P<0.001).There was a significant difference between the two groups in risk classification based on Caprini scale(P<0.05),and the patients with high risk or extremely high risk accounted for a higher proportion among the patients with VTE.The univariate analysis showed that there were significant differences between the two groups in age(t=6.400,P<0.001),catheterization method(χ^(2)=14.413,P<0.001),number of times of artificial liver support therapy(Z=-4.720,P<0.001),activity(Z=-6.282,P<0.001),infection(χ^(2)=33.071,P<0.001),D-dimer(t=8.746,P<0.001),28-day mortality rate(χ^(2)=5.524,P=0.022).The multivariate ana

关 键 词：肝功能衰竭 静脉血栓栓塞 肝 人工 危险因素 模型 统计学 

分 类 号：R575.3[医药卫生—消化系统] R543.6[医药卫生—内科学]