基于Caprini血栓风险评分及D-二聚体构建老年髋部骨折术后深静脉血栓形成的风险预测模型  

Risk prediction model for deep vein thrombosis after hip fracture surgery in the elderly based on Caprini thrombosis risk score and D-dimer

作　　者：赵晓勇 刘弘扬[1] 任原 ZHAO Xiaoyong;LIU Hongyang;REN Yuan(Department of Elderly Orthopedics,The Second Hospital of Tangshan,Tangshan,Hebei 063000,China;Department of Foot and Ankle Surgery,The Second Hospital of Tangshan,Tangshan,Hebei 063000,China)

机构地区：[1]唐山市第二医院老年骨科,河北唐山063000 [2]唐山市第二医院足踝外一科,河北唐山063000

出　　处：《安徽医药》2024年第12期2452-2457,I0010,共7页Anhui Medical and Pharmaceutical Journal

基　　金：河北省医学科学课题研究计划(20221737)。

摘　　要：目的基于Caprini血栓风险(CRS)评分及D-二聚体(D-D)构建老年髋部骨折术后深静脉血栓形成(DVT)的风险预测模型。方法选取2019年8月至2022年7月唐山市第二医院收治的206例拟接受髋部骨折手术的老年病人,依据术后有无发生DVT分为DVT组(52例)和对照组(154例),比较两组CRS、D-D及基线资料。采用二元logistic回归模型分析老年髋部骨折术后DVT的危险因素,建立风险预测模型,并对模型进行验证和效能评估。结果老年髋部骨折术后DVT发生率为25.24%。DVT组合并糖尿病、受伤至入院时间>24 h、转子间骨折、腰硬联合麻醉、术后卧床时间>5 d病人占比及手术时间、总蛋白、肌酐、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-D[(1.64±0.13)mg/L比(1.17±0.10)mg/L]、CRS评分[(8.44±1.65)分比(4.26±1.10)分]均高于对照组(P<0.05)。二元logistic回归分析显示,受伤至入院时间>24 h(OR=2.04)、术后卧床时间>5 d(OR=4.54)、合并糖尿病(OR=2.31)、转子间骨折(OR=2.81)、D-D升高(OR=3.81)、CRS评分升高(OR=5.33)是老年髋部骨折病人术后发生DVT的独立危险因素(P<0.05);Bootstrap法内部验证显示,风险模型列线图的区分度良好[C-index指数=0.81,95%CI:(0.74,0.89)];校准曲线显示模型拟合度好(Hosmer-Lemeshowχ^(2)=0.30,P=0.126)。受试者操作特征曲线(ROC曲线)结果显示,列线图总分最佳截断值为175.5分,灵敏度、特异度、约登指数分别为84.61%、93.42%、0.78,曲线下面积为0.88[95%CI:(0.82,0.92),P<0.05],且列线图预测模型优于D-D和CRS评分单独的预测效能(P<0.05)。结论基于CRS评分及DD构建老年髋部骨折术后DVT风险列线图模型区分度、拟合度好,能够直观地预测DVT发生风险。Objective To construct a risk prediction model for deep vein thrombosis(DVT)after hip fracture surgery in the elderly based on the Caprini thrombosis risk score(CRS)and D-dimer(D-D).Methods A total of 206 elderly patients admitted to The Second Hospital of Tangshan for hip fracture surgery from August 2019 to July 2022 were selected and assigned into a DVT group(n=52)and control group(n=154)based on the presence or absence of DVT after surgery,and the CRS,D-D and baseline information of the two groups were compared.A binary logistic regression model was used to analyse the risk factors for postoperative DVT in elderly patients with hip fracture.A risk prediction model was established,being validated and assessed for the efficacy.Results The incidence of DVT after hip fracture in the elderly was 25.24%.The proportion of patients with diabetes mellitus,time from injury to hospital admission>24 hours,intertrochanteric fracture,combined lumbar and epidural anesthesia,postoperative bed time>5 days,and operation time,total protein,creatinine,prothrombin time(PT),activated partial thromboplastin time(APTT),D-D[(1.64±0.13)mg/L vs.(1.17±0.10)mg/L]and CRS score[(8.44±1.65)vs.(4.26±1.10)]in DVT group were higher than those in the control group(P<0.05).Binary logistic regression analysis results showed that time from injury to admission>24 h(OR=2.04),postoperative time in bed>5 d(OR=4.54),combined diabetes(OR=2.31),intertrochanteric fracture(OR=2.81),elevated D-D(OR=3.81),and elevated CRS score(OR=5.33)were independent risk factors for the development of DVT in postoperative elderly patients with hip fracture(P<0.05).Internal validation of the Bootstrap method showed good discrimination of the risk model column line plot[C-index=0.81,95%CI:(0.74,0.89)].Calibration curve showed good model fit(Hosmer-Lemeshowχ^(2)=0.30,P=0.126).The results of the receiver operating characteristic curve plotted showed that the best cut-off value for the total column line plot score was 175.5,with sensitivity,specificity and Jorden index of

关 键 词：髋骨折 老年人 术后深静脉血栓形成 Caprini血栓风险评分 D-二聚体 预测模型 

分 类 号：R473.6[医药卫生—护理学]