淋巴瘤患者超声引导下颈内静脉置管术后静脉血栓形成的危险因素评估  

Risk factors for internal jugular venous thrombosis in patients with lymphoma after ultrasound-guided internal jugular vein catheterization

作　　者：曹琨芃 王昕玥 吴柳希 邓红艳 李璐 徐超丽 叶新华 Kunpeng Cao;Xinyue Wang;Liuxi Wu;Hongyan Deng;Lu Li;Chaoli Xu;Xinhua Ye(Department of Ultrasound,The First Affiliated Hospital of Nanjing Medical University,Nanjing,210029,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)超声诊断科,南京210029

出　　处：《中华医学超声杂志（电子版）》2024年第3期310-318,共9页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨淋巴瘤患者在超声实时引导下行颈内静脉置管(IJVC)术后颈内静脉血栓形成的危险因素。方法回顾性分析2021年2月至2023年3月于南京医科大学第一附属医院超声诊断科接受超声引导下IJVC的108例淋巴瘤患者的临床及超声资料。根据术前超声检查颈内静脉内是否有血栓形成分为无血栓组(62例)和血栓组(46例)。采用单因素分析(独立样本t检验、Mann-Whitney非参数检验和χ2检验)比较2组临床资料及超声特征的差异。应用多因素Logistic回归筛选血栓形成的独立危险因素。基于独立危险因素及高危因素构建血栓形成的风险预测模型。采用受试者操作特征(ROC)曲线的曲线下面积(AUC)评估风险预测模型和各独立危险因素的预测效能,最后使用列线图将风险模型可视化并通过校准曲线和临床决策曲线分析验证量化模型的应用价值。结果单因素分析结果表明,与无血栓组比较,血栓组使用14G导管管径比例(67.4%vs 30.6%)、使用单腔管比例(73.9%vs 46.8%)、纤维蛋白原(FIB)水平[(3.36±1.01)g/L vs(2.80±0.75)g/L]、D-二聚体水平[5.04(3.49,1.89)mg/L vs 0.18(0.10,0.58)mg/L]、侵袭性淋巴瘤比例(91.3%vs 75.8%)、糖尿病患者比例(93.5%vs 77.4%)更高,血管管径[10.6(7.8,14.1)mm vs 8.8(7.5,11.3)mm]更大,活化部分凝血活酶时间(APTT)[28.30(26.08,30.55)s vs 30.05(27.60,31.50)s]更短,差异均具有统计学意义(χ2=15.672,P=0.001;χ2=8.002,P=0.005;t=-3.328,P=0.001;Z=-3.483,P<0.001;χ2=4.375,P=0.036;χ2=5.135,P=0.023;Z=-2.262,P=0.024;Z=-2.206,P=0.027)。多因素回归分析显示血管管径(OR=1.175,95%CI:1.016~1.358,P=0.029)、FIB(OR=2.332,95%CI:1.185~4.590,P=0.014)、糖尿病(OR=4.904,95%CI:1.017~23.652,P=0.048)与淋巴瘤患者接受超声引导下IJVC后血栓形成独立相关。风险预测模型预测淋巴瘤患者血栓形成的AUC为0.831,敏感度为78.3%,特异度为72.6%,约登指数为0.509,较各独立危险因素具有更好的诊断效能。列�Objective To identify risk factors for internal jugular venous thrombosis in patients with lymphoma after real-time ultrasound-guided internal jugular vein catheterization(IJVC)to provide guidance for its clinical prevention and treatment.Methods The clinical and ultrasonic data of 108 patients with lymphoma who received ultrasound-guided IJVC at The First Affiliated Hospital of Nanjing Medical University from February 2021 to March 2023 were collected.Based on whether there was thrombosis in the internal jugular vein assessed by vascular ultrasound before operation,the patients were divided into two groups:non-thrombotic group(n=62)and thrombus group(n=46).Differences in clinical and ultrasonic characteristics between the two groups were compared by univariate analysis.Independent risk factors were identified by multivariate logistic regression.A risk prediction model was constructed based on the identified independent risk factors and high-risk factors,and the predictive efficacy of the model and each independent risk factor was quantified by using the area under the receiver operating characteristic(ROC)curve(AUC).Finally,a nomogram was constructed based on multivariate logistic regression models to visualize the prediction model,and its prediction accuracy was evaluated using a calibration curve.Clinical effectiveness of the nomogram was evaluated by decision curve analysis.Results Univariate analysis demonstrated that the proportion of patients using 14G catheter(67.4%vs 30.6%)and single lumen tube(73.9%vs 46.8%),the levels of fibrinogen(FIB)[(3.36±1.01)g/L vs(2.80±0.75)g/L]and D-dimer[5.04(3.49,1.89)mg/L vs 0.18(0.10,0.58)mg/L],and the proportion of patients with aggressive lymphoma(91.3%vs 75.8%)and diabetes(93.5%vs 77.4%)were significantly higher,vascular diameter[10.6(7.8,14.1)mm vs 8.8(7.5,11.3)mm]was significantly larger,and activated partial thromboplastin time(APTT)[28.30(26.08,30.55)s vs 30.05(27.60,31.50)s]was significantly shorter in the thrombus group than in the non-thrombotic group(χ2=15.672

关 键 词：淋巴瘤 超声引导 颈内静脉置管 静脉血栓形成 

分 类 号：R445.1[医药卫生—影像医学与核医学] R733.4[医药卫生—诊断学]