血小板输注效果相关因素分析与预测模型构建改善策略分析  

Analysis of factors related to platelet transfusion effect and analysis of improvement strategies for building prediction models

作　　者：马玉[1] 杨劲[1] 孙仁俊[1] Ma yu;Yang jin;Sun renjun(Department of Blood Transfusion,Hefei Second People's Hospital 230001)

机构地区：[1]合肥市第二人民医院输血科,230001

出　　处：《现代科学仪器》2024年第6期179-184,共6页Modern Scientific Instruments

摘　　要：目的:探究血小板输注效果影响因素,构建相关预测模型并提出改善策略。方法:回顾性分析2021年01月至2022年07月输注血小板211人次临床资料,根据输注效果分为有效组(CCI≥4.5,n=125人次)和无效组(CCI<4.5,n=86人次)两组。收集两组临床资料,包括性别、年龄、身高、体重、血小板类型、发烧、出血、感染、输血次数、首次输血前血小板计数、首次输血前血红蛋白值、输入血小板总数,采用单因素和多因素Logistic回归分析影响不同种类血小板输注效果相关因素,构建输注预测模型,受试者工作特征曲线(ROC)分析模型预测效能。针对相关因素提出相应改善策略。结果:临床资料中,输注血小板类型主要为辐照单采血小板,占72.50%(153/211),输血次数“<3次”的占比多于“≥3次”,且部分患者伴有发烧、出血、感染等症状。单因素分析结果显示:两组在感染、脾肿大、输注次数比较上,差异有统计学意义(P<0.05)。Logistics回归分析结果显示感染、脾肿大、输血次数是影响血小板输注效果的独立因素(P<0.05)。得出联合预测模型Y=1.746*感染+1.253*脾肿大+1.554*输血次数-2.536,将模型代入ROC曲线发现,模型预测曲线下面积为0.811、标准错误0.031,95%置信区间0.751~0.871,特异度、敏感度、cut-off分别为78.4%、73.3%、0.440。结论:感染、脾肿大、输血次数是影响血小板输注效果的独立因素,基于上述因素构建的预测模型有一定参考价值,对于输注血小板治疗的患者,在治疗过程中需加强对感染的预防和控制,进行适当脾肿大管理,洗涤红细胞以减少输血反应和同种抗体的产生。Objective:To explore the influencing factors of platelet transfusion effect,construct the relevant prediction model and propose the improvement strategy.Methods:The clinical data of 211 patients receiving platelet transfusion from January 2021 to July 2022 were retrospectively analyzed and divided into two groups according to the infusion effect:effective group(CCI≥4.5,n=125 patients)and ineffective group(CCI<4.5,n=86 patients).Clinical data of the two groups were collected,including gender,age,height,weight,platelet type,fever,bleeding,infection,number of transfusions,platelet count before initial transfusion,hemoglobin value before initial transfusion,and total number of input platelets.Univariate and multivariate Logistic regression were used to analyze the factors affecting the effectiveness of platelet transfusion of different types,and the infusion prediction model was constructed.Receiver operating characteristic curve(ROC)analysis model prediction efficiency.Corresponding improvement strategies are proposed according to relevant factors.Results:In the clinical data,the main platelet transfusion type was irradiated monopexic platelet,accounting for 72.50%(153/211),and the number of blood transfusions"<3"was more than"≥3",and some patients with fever,bleeding,infection and other symptoms.The results of single factor analysis showed that there were significant differences in infection,splenomegaly and infusion times between the two groups(P<0.05).The results of Logistics regression analysis showed that infection,splenomegaly and the number of blood transfusion were independent factors affecting the platelet transfusion effect(P<0.05).The combined prediction model Y=1.746*infection+1.253*splenic enlargement+1.554*number of blood transfusions-2.536 was obtained.The ROC curve was inserted into the model and it was found that the area under the prediction curve of the model was 0.811,the standard error was 0.031,and the 95%confidence interval was 0.751~0.871.The specificity,sensitivity and cut-off were 78.4%

关 键 词：血小板 输血 效果 血小板计数 影响因素 改善策略 

分 类 号：R552[医药卫生—血液循环系统疾病]