下肢动脉硬化闭塞病人介入术后并发DVT的风险预测列线图模型构建及验证  

Construction and validation of a nomogram model for the risk prediction of DVT after interventional therapy in patients with lower limb arteriosclerotic occlusion

作　　者：刘要先[1] 李博 孟杨海 邓飞[2] LIU Yaoxian;LI Bo;MENG Yanghai;DENG Fei(Department of Interventional Intervention,Luohe Central Hospital,Luohe,He'nan 462000,China;Department of Endocrinology,Luohe Central Hospital,Luohe,He'nan 462000,China)

机构地区：[1]漯河市中心医院介入科,河南漯河462000 [2]漯河市中心医院内分泌科,河南漯河462000

出　　处：《安徽医药》2024年第1期100-104,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨下肢动脉硬化闭塞病人介入术后并发深静脉血栓(DVT)的风险因素,并构建DVT风险预测列线图模型及进行验证。方法回顾性分析2018年6月至2022年5月在漯河市中心医院进行经皮腔内介入术治疗的374例下肢动脉硬化闭塞病人的临床资料,根据术后是否并发DVT而将病人分为并发DVT组与未并发DVT组。对比两组一般资料,采用多因素logistic回归分析法分析下肢动脉硬化闭塞介入术后并发DVT的危险因素,并利用R软件与rms程序构建DVT风险预测列线图模型,且应用caret程序包通过Bootstrap法对其进行内部验证,计算模型一致性指数(C-index),并绘制受试者操作特征(ROC)曲线评价该模型的预测效能。结果374例下肢动脉硬化闭塞病人介入术后3个月内,DVT并发率为9.63%(36/374);并发DVT组年龄≥60岁占比、完全闭塞占比、术后卧床时间≥3 d占比及总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDLC)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板计数(PLT)均高于未并发DVT组[69.44%(25/36)比50.59%(171/338)、41.67%(15/36)比25.44%(86/338)、58.33%(21/36)比22.19%(75/338)、(4.96±1.02)mmol/L比(4.63±0.94)mmol/L、(2.09±0.26)mmol/L比(1.81±0.31)mmol/L、(3.65±0.54)mmol/L比(3.47±0.51)mmol/L、(3.45±0.62)g/L比(3.11±0.54)g/L、(0.67±0.11)mg/L比(0.38±0.06)mg/L、(246.85±42.74)×10^(9)/L比(205.16±39.68)×10^(9)/L](P<0.05),凝血酶时间(TT)低于未并发DVT组[(15.16±3.11)s比(16.33±3.14)s](P<0.05);多因素logistic回归分析结果显示年龄≥60岁、术后卧床时间≥3 d、TG、FIB、D-D、PLT均是下肢动脉硬化闭塞介入术后并发DVT的危险因素(P<0.05);基于多因素logistic回归分析结果而构建下肢动脉硬化闭塞介入术后并发DVT的风险预测列线图模型,其校正曲线结果显示标准曲线与校准预测曲线具有良好的贴合度;该模型C-index为0.88(0.81~0.89),ROC曲线下面积为0.85[95%CI:(0.78,0.91),Z=9.54,P<0.001]。结论基�Objective To investigate the risk factors for deep venous thrombosis(DVT)after interventional surgery in patients with lower limb arteriosclerotic occlusion and to construct and verify a risk prediction nomogram model for DVT.Methods The clinical data of 374 patients with lower limb arteriosclerotic occlusion who underwent percutaneous transluminal interventional therapy at Luohe Central Hospital from June 2018 to May 2022 were retrospectively analyzed,and the patients were divided into the DVT group and non-DVT group according to whether the DVT was concomitant after surgery.The general data of the two groups were compared,and the risk factors for DVT after interventional surgery with lower limb arteriosclerotic occlusion were analyzed by multivariate logistic regression analysis.R software and the rms program were used to construct a nomogram model for DVT risk prediction,and the caret package was used to verify the model by the bootstrap method,calculate the model consistency index(c-index),and plot the receiver operating characteristic(ROC)curve to evaluate the prediction efficiency of the model.Results The complication rate of DVT was 9.63%(36/374)in 374 patients with lower limb arteriosclerotic occlusion within 3 months of interventional surgery.The proportion of age≥60 years,the proportion of total occlusion,the proportion of postoperative bed-rest time≥3 d,and the total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),fibrinogen(FIB),D-dimer(D-D),and platelet count(PLT)in the DVT group were higher than those in the non DVT group[69.44%(25/36)vs.50.59%(171/338),41.67%(15/36)vs.25.44%(86/338),58.33%(21/36)vs.22.19%(75/338),(4.96±1.02)mmol/L vs.(4.63±0.94)mmol/L,(2.09±0.26)mmol/L vs.(1.81±0.31)mmol/L,(3.65±0.54)mmol/L vs.(3.47±0.51)mmol/L,(3.45±±0.62)g/L vs.(3.11±0.54)g/L,(0.67±0.11)mg/L vs.(0.38±0.06)mg/L,(246.85±42.74)×10^(9)/L vs.(205.16±39.68)×10^(9)/L](P<0.05),and thrombin time(TT)was lower than that in the non-DVT group[(15.16±3.11)s vs.(16.33±3.14)s](P<0

关 键 词：血管成形术 手术后并发症 静脉血栓形成 闭塞性动脉硬化 下肢 风险因素 列线图模型 

分 类 号：R654.4[医药卫生—外科学]