预测老年自发性脑出血患者深静脉血栓--基于MIMIC-Ⅳ数据库回顾性分析  

Predicting deep vein thrombosis in elderly patients with spontaneous cerebral hemorrhage:a retrospective analysis on MIMIC-IV database

作　　者：石琼娅 周立宇 张娇 李幸 田志 SHI Qiongya;ZHOU Liyu;ZHANG Jiao(Jishou University School of Medicine,Jishou 416000,China)

机构地区：[1]吉首大学医学院,吉首416000 [2]湘西土家族苗族自治州人民医院/吉首大学第一附属医院神经外科

出　　处：《临床神经外科杂志》2023年第3期327-331,共5页Journal of Clinical Neurosurgery

基　　金：湖南省科技创新平台与人才计划项目(2016SK4007);湖南省卫生健康委员会适宜技术推广项目(202218015878)。

摘　　要：目的探讨老年自发性脑出血(SICH)患者深静脉血栓的危险因素并进行预测模型构建。方法纳入MIMIC-Ⅳ数据库诊断为SICH的患者,根据是否发生深静脉血栓(DVT)分为非血栓组(687例)、血栓组(36例)。采用Logistic逐步后退方法筛选变量,建立一个新模型Model 1,并应用受试者工作特征曲线分别评价各独立危险因素及联合模型Model 1的预测效能。结果单因素分析显示,血栓组患者的体质量、身体质量指数(BMI)、体温、血氧饱和度(SpO_(2))、简化急性生理评分(SAPSⅡ)、ICU住院时长、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、单核细胞与淋巴细胞比值(MLR)及全身免疫炎症指数(SII)计算值均高于非血栓组,血栓组活化部分凝血活酶时间(APTT)值小于非血栓组,差异均具有统计学意义(P<0.05)。Logistic回归显示,BMI、SAPSⅡ评分、NLR、APTT为DVT的独立危险因素,基于这四个变量构建的联合模型Model 1灵敏度、特异度分别为87.27%、60.86%,曲线下面积为0.789(95%CI:0.720~0.858),该模型的各项指标均优异于单一指标。结论NLR、APTT、BMI结合SAPSⅡ评分对老年SICH患者下肢深静脉血栓有很好的预测价值,为老年SICH患者伴发DVT早期监测、预防、治疗提供相应理论依据。Objective To explore the risk factors of deep vein thrombosis in elderly patients with spontaneous intracerebral hemorrhage(SICH)and establish predictive models.Methods Patients diagnosed as SICH included in the MIMIC-IV database were divided into non thrombotic group(687 cases)and thrombotic group(36 cases)based on whether deep venous thrombosis(DVT)occurred.A logistic stepwise regression method was used to screen variables and establish a new model,model 1.The predictive efficacy of each independent risk factor and the combined model,model 1,were evaluated using the subject s job characteristic curve.Results Univariate analysis showed that the calculated values of body mass,body mass index(BMI),body temperature,blood oxygen saturation(SpO_(2)),simplified acute physiological score(SAPSⅡ),length of stay in ICU,neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),monocyte to lymphocyte ratio(MLR),and systemic immune inflammation index(SII)in the thrombotic group were higher than those in the non thrombotic group.The value of activated partial thromboplastin time(APTT)in the thrombotic group was smaller than that in the non thrombotic group,with statistically significant differences(P<0.05).Logistic regression showed that BMI,SAPSⅡscore,NLR,and APTT were independent risk factors for DVT.The sensitivity and specificity of the combined model 1 based on these four variables were 87.27%and 60.86%,respectively,and the area under the curve was 0.789(95%CI:0.720-0.858).All indicators of the model were superior to a single indicator.Conclusion NLR,APTT,BMI combined with SAPSⅡhave a good predictive value for DVT in elderly patients with SICH,providing the relevant theoretical basis for early monitoring,prevention and treatment of DVT in elderly patients with SICH.

关 键 词：深静脉血栓 自发性脑出血 NLR APTT SAPSⅡ评分 MIMIC-Ⅳ 

分 类 号：R651[医药卫生—外科学] R743.34[医药卫生—临床医学]