血栓弹力图对乙肝肝硬化患者脾切除术后门静脉血栓形成的预测价值及其列线图模型的构建  

Predictive value of thromboelastography for portal vein thrombosis after splenectomy in patients with hepatitis B cirrhosis and the construction of Nomogram model

作　　者：李瑾艳 吴予[2] 蒋旭燕 葛文贤 Li Jinyan;Wu Yu;Jiang Xuyan;Ge Wenxian(Department of Clinical Laboratory,Changzhou Wujin Traditional Chinese Medicine Hospital,Changzhou 213161,Jiangsu,China;Department of Vascular Surgery,Changzhou Wujin Traditional Chinese Medicine Hospital,Changzhou 213161,Jiangsu,China)

机构地区：[1]常州市武进中医医院检验科,江苏常州213161 [2]常州市武进中医医院血管外科,江苏常州213161

出　　处：《血管与腔内血管外科杂志》2024年第10期1264-1269,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨乙型病毒性肝炎(简称乙肝)肝硬化患者脾切除术后门静脉血栓形成与血栓弹力图参数的关系及临床危险因素,据此构建列线图预测风险模型。方法收集2020年1月至2023年1月于常州市武进中医医院接受脾切除手术治疗的103例乙肝肝硬化患者的临床资料,根据术后是否发生门静脉血栓将患者分为血栓组(n=39)和无血栓组(n=64)。分析乙肝肝硬化患者的临床特征、术后24 h血栓弹力图参数与乙肝肝硬化脾切除术后门静脉血栓形成之间的关系,探讨乙肝肝硬化脾切除术后门静脉血栓形成的危险因素,并代入Nomogram模型绘制列线图,并对列线图进行内部校验与外部校验,同时通过绘制受试者工作特征(ROC)曲线分析列线图的风险预测价值。结果血栓组患者的R值低于无血栓组患者,差异有统计学意义(P﹤0.05)。血栓组患者门静脉直径﹥10 mm、脾静脉直径﹥12 mm、脾脏肿大、中重度门静脉曲张及血栓弹力图R值﹤5 min的比例均高于无血栓组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,门静脉直径﹥10 mm、脾静脉直径﹥12 mm、脾脏肿大、中重度门静脉曲张及血栓弹力图R值﹤5 min均为乙肝肝硬化脾切除术后门静脉血栓形成的危险因素(P﹤0.05)。据此构建的列线图预测模型经内部校正分析具有较好的预测准确性(C指数=0.890,P﹤0.05),经ROC曲线分析具有较高的预测价值(曲线下面积=0.882,95CI:0.794~0.969,P﹤0.05),经外部校正具有较好的临床应用效果。结论血栓弹力图参数R值联合临床危险因素构建的列线图风险预测模型对于乙肝肝硬化患者脾切除术后门静脉血栓形成具有较好的预测价值,预测准确率较高,临床应用效果较好。Objective To investigate the relationship between portal vein thrombosis(PVT)after splenectomy and the indexes of thromboelastography in patients with hepatitis B cirrhosis and the clinical risk factors of portal vein thrombosis after splenectomy,and to construct a Nomogram prediction risk model.Method The clinical data of 103 patients with hepatitis B cirrhosis who received splenectomy in Changzhou Wujin Traditional Chinese Medicine Hospital from January 2020 to January 2023 were collected.The patients were divided into thrombosis group(n=39)and non-thrombosis group(n=64)according to whether there was portal vein thrombosis after surgery.The relationship between the clinical characteristics of patients with hepatitis B cirrhosis,the parameters of thromboelastography 24 h after surgery and portal vein thrombosis after splenectomy for hepatitis B cirrhosis were analyzed,the risk factors of portal vein thrombosis after splenectomy for hepatitis B cirrhosis was explored,the analysis results was substituted into the Nomogram model to draw a column chart,and perform internal and external validation on the column chart.At the same time,the predictive value of the column chart was analyzed by drawing the ROC curve of the subjects.Result The R value of patients in thrombosis group was lower than that of patients in non-thrombosis group,and the difference was statistically significant(P<0.05).The proportion of portal vein diameter>10 mm,splenic vein diameter>12 mm,splenomegaly moderate and severe portal varicose veins,and thromboelastography R value<5 min in thrombosis group were higher than those in non-thrombosis group,and the differences were statistically significant(P<0.05);portal vein diameter>10 mm,splenic vein diameter>12 mm,splenomegaly moderate and severe portal varicose veins,and thromboelastogram R value<5 min were risk factors for portal vein thrombosis after splenectomy for hepatitis B cirrhosis(P<0.05).The Nomogram prediction model built on this basis has good prediction accuracy(C index=0.890,P<0.05)after

关 键 词：肝硬化 乙型病毒性肝炎 脾切除术 血栓弹力图 列线图 

分 类 号：R543[医药卫生—心血管疾病]