下肢深静脉血栓清除后血栓后综合征的危险因素分析  

Risk factors for post-thrombotic syndrome after removal of lower extremity deep vein thrombosis

作　　者：韩松[1] 康涛[1] 徐前 周跃 陆耀良[1] HAN Song;KANG Tao;XU Qian;ZHOU Yue;LU Yaoliang(Department of Vascular Surgery,Taicang First People's Hospital,Suzhou,Jiangsu,215400,China)

机构地区：[1]太仓市第一人民医院血管外科,江苏苏州215400

出　　处：《临床急诊杂志》2023年第12期647-652,共6页Journal of Clinical Emergency

摘　　要：目的:分析下肢深静脉血栓清除后血栓后综合征(post-thrombotic syndrome,PTS)的危险因素,并构建PTS的列线图(nomogram)预测模型。方法:选取2019年10月-2021年11月太仓市第一人民医院接诊并治疗的166例下肢深静脉血栓患者为研究对象,根据Villalta评分将患者分为PTS组(48例)和非PTS组(118例)。比较两组患者的一般资料,采用受试者工作特征(receiver operating characteristic,ROC)曲线实验分析有统计学意义的连续性变量的预测价值,采用logistic回归实验分析下肢深静脉血栓清除后PTS的危险因素,采用内部数据验证nomogram模型临床效能。结果:与非PTS组比较,PTS组患者BMI较高、病程较长,血栓清除分级Ⅰ/Ⅱ级占比、静脉曲张占比较高,差异有统计学意义(P<0.05);BMI、病程的曲线下面积为0.694、0.757,最佳截断值为24.08 kg/m^(2)、14 d;BMI(>24.08 kg/m^(2))、病程(>14 d)、血栓清除分级(Ⅰ/Ⅱ级)、静脉曲张(是)是影响下肢深静脉血栓清除后PTS的危险因素(P<0.05);nomogram模型预测下肢深静脉血栓清除后PTS的风险C-index为0.880(0.822~0.939);模型预测下肢深静脉血栓清除后PTS的风险阈值>0.07。结论:BMI(>24.08 kg/m^(2))、病程(>14 d)、血栓清除分级(Ⅰ/Ⅱ级)、静脉曲张(是)是影响下肢深静脉血栓清除后PTS的危险因素,且基于以上变量构建的nomogram模型有较好的预测价值,尽早监测及早期预防,可以最大限度降低PTS的发生概率。Objective To analyse the risk factors for post-thrombotic syndrome(PTS)after removal of lower limb deep vein thrombosis and to construct a nomogram prediction model for PTS.Methods One hundred and sixty-six patients with lower limb deep vein thrombosis who came to our hospital and were treated from October 2019 to November 2021 were selected for the study,and the patients were divided into PTS group(n=48)and no PTS group(n=118)according to Villalta score.The general data of the patients in the two groups were compared.The predictive value of statistically significant continuous variables was analysed by the receiver operating characteristic curve(ROC)test.The risk factors for PTS after removal of lower limb DVT were analysed by the logistic regression test.And the clinical efficacy of the nomogram model was verified using internal data.Results Compared with the non-PTS group,patients in the PTS group had higher BMI,longer disease duration,higher percentage of thrombus clearance gradeⅠ/Ⅱ,and higher percentage of varicose veins(P<0.05).The area under curve of BMI and disease duration were 0.694 and 0.757,and the best cut-off values were 24.08 kg/m^(2)and 14 days.BMI(>24.08 kg/m^(2)),disease duration(>14 days),thrombus clearance grade(gradeⅠ/Ⅱ),and varicose veins(yes)were risk factors affecting post-thrombotic syndrome after lower extremity deep vein thrombosis clearance(P<0.05).The nomogram model predicted a risk C-index of 0.880(0.822-0.939)for post-thrombotic syndrome after lower extremity deep vein thrombosis clearance.The model predicted a risk threshold for post-thrombotic syndrome after lower extremity deep vein thrombosis clearance>0.07.Conclusion BMI(>24.08 kg/m^(2)),disease duration(>14 days),thrombus clearance grade(gradeⅠ/Ⅱ),and varicose veins(yes)are risk factors affecting post-thrombotic syndrome after lower extremity deep vein thrombus clearance,and the nomogram model constructed based on the above variables have good predictive value.Early monitoring and early prevention minimize the prob

关 键 词：下肢深静脉血栓 血栓后综合征 危险因素 nomogram预测模型 

分 类 号：R654.4[医药卫生—外科学]