剖宫产术后并发下肢DVT的风险因素及预测诺谟图模型构建、验证  

Risk Factors for Lower Limb DVT after Cesarean Section and Construction and Validation of a Predictive Nomogram Model

作　　者：张静蕾[1] 马媛媛 王美丽 徐流立[1] ZHANG Jinglei;MA Yuanyuan;WANG Meili(Department of Obstetrics and Gynecology,Anyang Regional Hospital of Puyang City,Anyang City,He’nan Province 455000;不详)

机构地区：[1]濮阳市安阳地区医院妇产科,河南省安阳市455000 [2]安阳市中医院妇产科

出　　处：《医学理论与实践》2024年第9期1466-1470,共5页The Journal of Medical Theory and Practice

摘　　要：目的:探讨剖宫产术后并发下肢深静脉血栓形成(DVT)的风险因素,构建预测诺谟图模型并验证。方法:回顾性分析2017年1月—2023年7月在本院进行剖宫产术的2783例患者临床资料,按照2∶1的比例将其随机分为建模组(n=1855)与验证组(n=928)。根据术后下肢DVT并发情况,进一步将建模组患者分为并发组(n=55)与未并发组(n=1800)。采用多因素Logistic回归分析确定剖宫产术后并发下肢DVT的危险因素,并据此构建预测诺谟图模型。采用Bootstrap法验证模型,绘制校准曲线、受试者工作特征(ROC)曲线和决策曲线分析(DCA)评估模型的区分度、校准度和临床有效性。结果:并发组年龄≥35岁、产前体质量指数(BMI)≥30kg/m^(2)、产褥期卧床时间≥3d、产后出血≥1000mL、高血压史、糖尿病史占比及术前D-二聚体(D-D)、术前纤维蛋白原(FIB)、术前纤维蛋白原降解产物(FDP)、术后D-D水平均高于未并发组(P<0.05),术前活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)均短于未并发组(P<0.05);经多因素Logistic分析,年龄≥35岁、产前BMI≥30kg/m^(2)、产褥期卧床时间≥3d、产后出血≥1000mL、糖尿病史、术前APTT、术前PT、术前TT、术前D-D、术前FIB、术前FDP、术后D-D均是剖宫产术后并发下肢DVT的危险因素(P<0.05);根据上述多因素Logistic回归分析结果建立剖宫产术后并发下肢DVT的风险预测诺谟图模型,对其进行内外部验证,建模组、验证组一致性指数分别为0.846、0.833,校准曲线与理想曲线均吻合较好;ROC曲线显示建模组曲线下面积、灵敏度、特异度分别为0.887、84.62%、82.56%,验证组分别为0.856、81.48%、80.81%;DCA曲线表示当阈值概率为0~0.9时,诺谟图模型预测剖宫产术后并发下肢DVT风险的净获益高。结论:年龄≥35岁、产前BMI≥30kg/m^(2)、产褥期卧床时间≥3d、产后出血≥1000mL、糖尿病史、术前APTT、术前PT、术前Objective:To explore the risk factors for lower limb deep vein thrombosis(DVT)after cesarean section,and construct a predictive nomogram model and validate it.Methods:The clinical data of 2783 patients who underwent cesarean section in our hospital from January 2017 to July 2023 were retrospectively analyzed,and they were randomly divided into modeling group(n=1855)and validation group(n=928)according to a 2∶1 ratio.Based on the postoperative complications of lower limb DVT,the modeling group patients were further divided into a concurrent group(n=55)and a non concurrent group(n=1800).The risk factors for lower limb DVT after cesarean section was determined by using multiple Logistic regression analysis,and a predictive nomogram model was constructed based on this.The model was validated by using the Bootstrap method,and the discrimination,calibration and clinical effectiveness of the model were evaluated by drawing calibration curves,receiver operating characteristic(ROC)curves and decision curve analysis(DCA).Results:The proportions of age≥35 years old,prenatal body mass index(BMI)≥30kg/m^(2),bed rest time during postpartum period≥3 days,postpartum hemorrhage≥1000mL,history of hypertension,history of diabetes and the levels of preoperative D-dimer(D-D),preoperative fibrinogen(FIB),preoperative fibrinogen degradation products(FDP),postoperative D-D in the concurrent group were higher than those in the non concurrent group(P<0.05),while preoperative activated partial thromboplastin time(APTT),prothrombin time(PT)and thrombin time(TT)were shorter than those in the non concurrent group(P<0.05).Multivariate Logistic analysis showed that age≥35 years,prenatal BMI≥30kg/m^(2),bed rest time during postpartum period≥3 days,postpartum hemorrhage≥1000mL,diabetes history,preoperative APTT,preoperative PT,preoperative TT,preoperative D-D,preoperative FIB,preoperative FDP and postoperative D-D were all risk factors for lower limb DVT after cesarean section(P<0.05).Based on the above multiple factor Logistic

关 键 词：剖宫产 深静脉血栓形成 危险因素 诺谟图 

分 类 号：R719.8[医药卫生—妇产科学] R619[医药卫生—临床医学]