血液病患者PICC置管术后相关性静脉血栓影响因素的Logistic回归分析  

Logistic regression analysis of factors influencing peripherally inserted central catheter⁃related venous thrombosis in hematologic disorders

作　　者：苏醒 宋振 张慧敏 邵帅 Su Xing;Song Zhen;Zhang Huimin;Shao Shuai(Hematology Hospital,Chinese Academy of Medical Sciences(Institute of Hematology,Chinese Academy of Medical Sciences),State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood System Diseases,Haihe Laboratory of Cell Ecology,Tianjin Medical and Health Research Institute,Tianjin 300021)

机构地区：[1]中国医学科学院血液病医院(中国医学科学院血液学研究所),实验血液学国家重点实验室,国家血液系统疾病临床医学研究中心,细胞生态海河实验室,天津医学健康研究院,天津300021

出　　处：《血栓与止血学》2024年第1期10-15,共6页Chinese Journal of Thrombosis and Hemostasis

基　　金：中国医学科学院医学与健康科技创新工程项目(2021-I2M-C&T-B-085)。

摘　　要：目的 经外周置入中心静脉导管是维持血液病患者静脉治疗的首选方法,本研究主要探究血液病患者在PICC置管后导管相关性静脉血栓(PICC-RVT)的发生率及其影响因素。方法 通过回顾性分析2018年01月至2022年12月在中国医学科学院血液病医院(中国医学科学院血液学研究所)置入PICC导管的4 345例患者,收集其一般资料、实验室指标、相关置管信息及用药情况。采用1∶5倾向性评分匹配(PSM)平衡血栓与非血栓组之间的基线特征,采用二元Logistic回归分析探究血液病患者PICC置管术后发生PICC-RVT的影响因素,根据受试者工作特征(ROC)曲线分析对多因素结果进行验证。结果 4 345例血液病患者中有63人发生PICC-RVT,血栓发生率为1.45%。经PSM平衡后得到血栓组63例,非血栓组388例共451例。二元Logistic回归分析显示,影响血液病患者发生PICC-RVT的因素是诊断(OR=0.429,P<0.001)、体质指数(BMI)(OR=0.504,P<0.05)、白细胞计数(OR=0.443,P<0.001)、血小板计数(OR=1.902,P<0.05)、D-二聚体水平(OR=1.135,P<0.05)、是否输入血制品(OR=3.348,P<0.001)。ROC曲线下面积(AUC)为0.847,灵敏度0.794、特异性0.753,用于判断PICC-RVT有显著意义(P<0.001)。结论 本研究结果显示诊断、BMI、WBC、PLT、D-二聚体水平和输入血制品会增加血液病患者PICC-RVT的发生几率,是其影响因素。Background Peripherally inserted central catheter(PICC)is the preferred vascular access method in patients with hematologic disorders.This study examined the incidence and influential factors of PICC-related venous thrombosis(PICC-RVT)in patients with hematologic disorders.Methods Patients with hematologic disorders who underwent PICC placement at our hospital between January 2018 and December 2022 were included.General characteristics,laboratory results,and relevant PICC and medication data were collected.Baseline characteristics between the thrombotic and non-thrombotic groups were balanced using 1∶5 propensity score matching(PSM).Binary logistic regression analysis was used to investigate the factors influencing PICC-RVT development.Multivariate regression results were validated using receiver operating characteristic(ROC)curve analysis.Results In total,63 of 4345(1.45%)patients who developed PICC-RVT were recruited.After PSM balancing,63 cases were in the thrombosis group and 388 cases in the non-thrombosis group,and a total of 451 cases were analyzed.Binary logistic regression analysis showed that factors affecting the occurrence of PICC-RVT in patients with hematological disorders were diagnosis(OR=0.429,P<0.001),body mass index(BMI)(OR=0.504,P<0.05),white blood cell count(WBC)(OR=0.443,P<0.001),platelet count(OR=1.902,P<0.05),,D-dimer level(OR=1.135,P<0.05)and blood product transfusion(OR=3.348,P<0.001).The area under the ROC curve was 0.847,and the sensitivity and specificity were 0.794 and 0.753,respectively,indicating that the model was significant for predicting PICC-RVT(P<0.001).Conclusion Diagnosis.,BMI,WBC,PLT,D-D,blood product transfusion influenced the probability of PICC-RVT in patients with hematologic disorders.

关 键 词：血液病 PICC 相关性静脉血栓 影响因素 LOGISTIC 

分 类 号：R619.2[医药卫生—外科学]