剖宫产术后静脉血栓栓塞症危险因素分析及风险预测模型构建  

Analysis of risk factors and construction of a risk prediction model for venous thromboembolism after cesarean section

作　　者：雷静[1] 宋欣燕[1] 杜亚蕾 王玙瑕 Lei Jing;Song Xinyan;Du Yalei(Department of Obstetrics,the First Affiliated Hospital of Kunming Medical University,Kunming 650031)

机构地区：[1]昆明医科大学第一附属医院产科,昆明650031

出　　处：《现代妇产科进展》2023年第8期576-580,共5页Progress in Obstetrics and Gynecology

基　　金：研究生创新基金项目(No:2022S061)。

摘　　要：目的:探讨剖宫产术后静脉血栓栓塞症(VTE)的危险因素及构建风险预测模型。方法:选取2017年1月~2022年10月在昆明医科大学第一附属医院产科行剖宫产术并发VTE的患者58例(VTE组)和未发生VTE的患者174例(对照组)。收集两组患者的一般临床资料,包括年龄、分娩时体质量指数(BMI)、孕期增重、胎儿数量、妊娠期糖尿病(GDM)、子痫前期、产后出血、产后输血、前置胎盘、辅助生殖技术及孕产史等。分析剖宫产术后VTE的影响因素,logistic回归分析剖宫产术后VTE发生的独立危险因素。构建风险预测模型,Hosmer Lemeshow检验评估模型拟合优度、受试者工作特征(ROC)曲线及曲线下面积(AUC)检测该模型的预测效能。结果:VTE组和对照组的年龄、分娩时BMI、孕期增重、辅助生殖技术、子痫前期、产后出血比较,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,高龄、分娩时BMI≥30kg/m 2、子痫前期、产后出血是发生剖宫产术后VTE的独立危险因素(P<0.05)。风险预测模型表达式Y=1/[1+e^(-1.115×高龄+1.039×分娩时BMI≥30kg/m 2+1.279×子痫前期+0.978×产后出血-2.097)],Hosmer Lemeshowχ2=2.357,P=0.798,剖宫产术后VTE发生的AUC为0.757。结论:VTE是受多种危险因素相互作用的结果,联合高龄、分娩时BMI≥30kg/m 2、子痫前期、产后出血建立的风险预测模型具有较高预测价值。Objective:To investigate the risk factors and construct a risk prediction model for venous thromboembolism(VTE)after cesarean section.Methods:Fifty-eight patients who underwent cesarean section and developed VTE in the Department of Obstetrics of the First Affiliated Hospital of Kunming Medical University from January 2017 to October 2022(VTE group)and 174 patients who did not develop VTE(control group)were selected.General clinical data were collected from both groups,including age,body mass index(BMI)at delivery,weight gain during pregnancy,number of fetuses,gestational diabetes,preeclampsia,postpartum hemorrhage,postpartum transfusion,placenta praevia,assisted reproductive technology,and maternal history.The factors affecting VTE after cesarean delivery were analyzed,and independent risk factors for the occurrence of VTE after cesarean delivery were obtained by logistic regression analysis.A risk prediction model was constructed,and the Hosmer Lemeshow test was used to assess the model goodness of fit,the subject work characteristic(ROC)curve and the area under the curve(AUC)to detect the predictive efficacy of the model.Results:There was a statistically significant difference between the VTE group and the control group in terms of age,BMI at delivery,excessive weight gain during pregnancy,assisted reproductive technology,preeclampsia,and postpartum hemorrhage(P<0.05).Logistic regression analysis showed that advanced age,BMI≥30kg/m 2 at delivery,preeclampsia,and postpartum hemorrhage were independent risk factors(P<0.05).The risk prediction model expression Y=1/[1+e^(-1.115×advanced age+1.039×BMI≥30kg/m 2 at delivery+1.279×pre-eclampsia+0.978×postpartum hemorrhage-2.097)],Hosmer Lemeshowχ2=2.357,P=0.798,and the AUC for the occurrence of VTE after cesarean delivery of AUC was 0.757.Conclusions:VTE is subject to the interaction of multiple risk factors,and the risk prediction model established by combining advanced age,BMI≥30kg/m 2 at delivery,preeclampsia,and postpartum hemorrhage has a high predicti

关 键 词：产褥期 静脉血栓栓塞症 肺栓塞 深静脉血栓形成 危险因素 

分 类 号：R71.2[医药卫生—妇产科学]