肺癌化疗病人发生PICC相关上肢静脉血栓风险Nomogram模型的构建  

Establishment of a Nomogram model to individually predict the risk of PICC-associated upper limb venous thrombosis in patients undergoing chemotherapy for lung cancer

作　　者：王惠萍[1] 曹英[1] WANG Huiping;CAO Ying(The First Affiliated Hospital of Nanchang University,Jiangxi 330006 China)

机构地区：[1]南昌大学第一附属医院,江西330006

出　　处：《护理研究》2024年第15期2668-2674,共7页Chinese Nursing Research

摘　　要：目的:探究肺癌化疗病人发生经外周静脉置入中心静脉导管(PICC)相关上肢静脉血栓的危险因素,构建其风险Nomogram模型,并进一步验证该模型的预测价值。方法:回顾性分析2014年1月—2020年12月南昌大学第一附属医院呼吸内科收治的391例原发性肺癌化疗病人,比较病人的临床资料,并采用多因素Logistic回归模型分析肺癌化疗病人发生PICC相关上肢静脉血栓的独立危险因素,R软件整合独立危险因素并构建Nomogram模型。结果:89例(22.76%)肺癌化疗病人出现PICC相关上肢静脉血栓。体质指数(≥27.49 kg/m^(2))、糖尿病(是)、纤维蛋白原(FIB)(≥3.60 g/L)、活化部分凝血活酶时间(APTT)(≥33 s)、D-二聚体(≥0.90 mg/L)以及C反应蛋白(CRP)(≥5.80 mg/L)是肺癌化疗病人发生PICC相关上肢静脉血栓的独立危险因素(P<0.05)。该Nomogram模型预测与实际观测结果的吻合度较好,一致性指数(C-index)为0.832[95%CI(0.793,0.866)],当高风险阈值>0.05时,此Nomogram模型在预测肺癌化疗病人PICC相关上肢静脉血栓高风险的方面可提供高于单个独立危险因素的额外临床净收益。结论:基于体质指数、糖尿病、纤维蛋白原、活化部分凝血活酶时间、D-二聚体以及C反应蛋白独立危险因素构建的Nomogram模型在预测肺癌化疗病人发生PICC相关上肢静脉血栓具备可行性,可为临床风险分层及制定护理策略提供重要参考。Objective:To investigate the risk factors of peripherally inserted central catheter(PICC)related upper limb venous thrombosis in lung cancer patients undergoing chemotherapy,construct a Nomogram model of the risk,and further verify the predictive value of this model.Methods:A total of 391 patients with primary lung cancer undergoing chemotherapy in the Department of Respiratory Medicine of our hospital from January 2014 to December 2020 were selected.The clinical data of the patients were compared and the independent risk factors of PICC-related upper limb venous thrombosis in patients with lung cancer undergoing chemotherapy were analyzed by multivariate Logistic regression model.R software integrates independent risk factors and constructs Nomogram models.Results:PICC-related upper limb vein thrombosis occurred in 89 patients(22.76%)receiving chemotherapy for lung cancer.BMI(≥27.49 kg/m^(2)),diabetes(yes),FIB(≥3.60 g/L),APTT(≥33 s),D-D(≥0.90 mg/L)and CRP(≥5.80 mg/L)were independent risk factors for PICC-related upper limb venous thrombosis in patients with lung cancer chemotherapy(P<0.05).The prediction of this Nomogram model is in good agreement with the actual observation,with a C-index of 0.832(95%CI 0.793-0.866),When the risk threshold is>0.05,this Nomogram model can provide additional clinical net benefit over individual risk factors in predicting the high risk of PICC related upper limb venous thrombosis in lung cancer chemotherapy patients.Conclusion:This Nomogram model based on BMI,diabetes,FIB,APTT,D-D,CRP and other independent risk factors is feasible to predict PICC-related upper limb venous thrombosis in patients with lung cancer chemotherapy,and can provide a important reference for clinical risk stratification and nursing strategy.

关 键 词：肺癌 化疗 经外周置入中心静脉导管 上肢静脉血栓 Nomogram模型 影响因素 

分 类 号：R473.73[医药卫生—护理学]