结直肠癌术后24小时内发生下肢深静脉血栓的危险因素分析及Nomogram预测模型构建  

Risk factors analysis and Nomogram prediction model construction for lower extremity deep vein thrombosis within 24 hours after colorectal cancer surgery

作　　者：杜润森 董瑞涛 姜霞[3,4,5] 张磊 李中信[1,3] 赵增仁 Du Runsen;Dong Ruitao;Jiang Xia;Zhang lei;Li Zhongxin;Zhao Zengren(Department of General surgery,the First Hospital of Hebei Medical University,Shijiazhuang 050011,Hebei,China;Department of vascular surgery,the First Hospital of Hebei Medical University,Shijiazhuang 050011,Hebei,China;Gastroenterology Center,the First Hospital of Hebei Medical University,Shijiazhuang 050011,Hebei,China;Central laboratory,the First Hospital of Hebei Medical University,Shijiazhuang 050011,Hebei,China;Hebei Provincial Key Laboratory of Accurate Diagnosis and Treatment of Colorectal Cancer,Shijiazhuang 050011,Hebei,China)

机构地区：[1]河北医科大学第一医院普外科,河北石家庄050011 [2]河北医科大学第一医院血管外科,河北石家庄050011 [3]河北医科大学第一医院胃肠病诊疗中心,河北石家庄050011 [4]河北医科大学第一医院中心实验室,河北石家庄050011 [5]河北省大肠癌精准诊断与治疗重点实验室,河北石家庄050011

出　　处：《血管与腔内血管外科杂志》2024年第9期1066-1072,共7页Journal of Vascular and Endovascular Surgery

基　　金：国家省自然科学青年基金(82203623)。

摘　　要：目的探讨结直肠癌患者术后24 h内发生下肢深静脉血栓(DVT)的危险因素并构建Nomogram预测模型。方法收集2021年6月至2023年6月于河北医科大学第一医院行结直肠癌手术的225例患者的临床资料,根据术后24 h内是否发生下肢DVT将其分为DVT组(n=70)和非DVT组(n=155),分析结直肠癌患者术后24 h内发生下肢DVT的独立危险因素,基于独立危险因素构建Nomogram预测模型。结果单因素分析结果显示,DVT组患者年龄≥60岁、新辅助化疗、便血、麻醉时间、手术时间、输血、高密度脂蛋白胆固醇、Caprini评分均高于非DVT组患者,活化部分凝血活酶时间短于非DVT组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,年龄≥60岁、便血、新辅助化疗、手术时间、输血均是结直肠癌患者术后24 h内发生下肢DVT的独立危险因素(P﹤0.05)。将上述危险因素作为构建Nomogram预测模型的预测因子,其受试者工作特征(ROC)曲线显示,灵敏度、特异度分别为80.0%、63.2%,曲线下面积(AUC)为0.776。结论年龄≥60岁、便血、新辅助化疗、手术时间、输血均是结直肠癌患者术后24 h内发生下肢DVT的独立危险因素,基于此构建的Nomogram模型为结直肠癌患者术后发生DVT的防治提供重要策略指导。Objective To investigate the risk factors of lower extremity deep vein thrombosis(DVT)in patients with colorectal cancer within 24 h after surgery and establish the Nomogram prediction model.Method Clinical data of 225 patients undergoing colorectal cancer surgery in the First Hospital of Hebei Medical University from June 2021 to June 2023 were collected.According to whether lower extremity DVT occurred within 24 h after surgery,they were divided into DVT group(n=70)and non-DVT group(n=155).The independent risk factors for lower extremity DVT in patients with colorectal cancer within 24 h after surgery was analyzed,the Nomogram prediction model based on the independent risk factors was constructed.Result The results of univariate analysis showed that patients aged≥60 years old,neoadjuvant chemotherapy,hematostoecia,anesthesia time,operation time,blood transfusion,the high density lipoprotein cholesterol,and the Caprini score in the DVT group were all higher than those in the non-DVT group,and the preoperative activation time of partial thromboplastin in the DVT group was shorter than that in the non-DVT group,the differences were statistically significant(P<0.05).Multivariate analysis showed that age≥60 years old,hematochezia,neoadjuvant chemotherapy,operation time and blood transfusion were independent risk factors for lower extremity DVT within 24 h after surgery in colorectal cancer patients(P<0.05).The above risk factors were used as predictive factors for constructing the Nomogram prediction model,the receiver operating characteristic(ROC)curve showed sensitivity and specificity of 80.0%and 63.2%,respectively,the area under curve(AUC)was 0.776.Conclusion Age≥60 years old,hematochezia,neoadjuvant chemotherapy,operation time,and blood transfusion are all independent risk factors for lower extremity DVT in patients with colorectal cancer within 24 h after surgery.This Nomogram model will provide important strategic guidance for the prevention and treatment of lower extremity DVT in patients with colorect

关 键 词：结直肠癌 下肢深静脉血栓 危险因素 风险评估模型 

分 类 号：R543[医药卫生—心血管疾病]