基于倾向性评分匹配分析风湿性心脏病心脏瓣膜置换术后并发下肢DVT的危险因素  

Risk factors of lower extremity deep vein thrombosis after cardiac valve replacement for rheumatic heart disease:an analysis based on propensity score matching

作　　者：高源 王俊生[1] 杨书强[1] Gao Yuan;Wang Junsheng;Yang Shuqiang(Department of Cardiac-Vascular Surgery,People's Hospital of Anyang City,Anyang 455001,China;不详)

机构地区：[1]安阳市人民医院心脏大血管外科,安阳455001

出　　处：《中国循证心血管医学杂志》2024年第12期1496-1501,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的基于倾向性评分匹配法(PSM)均衡混杂因素,分析风湿性心脏病(RHD)心脏瓣膜置换术后并发下肢深静脉血栓形成(DVT)的危险因素。方法回顾性分析2018年1月至2023年1月于安阳市人民医院心脏大血管外科行心脏瓣膜置换术的389例RHD患者的临床资料,根据术后1周内是否并发下肢DVT其分为并发组(n=35)和未并发组(n=354)。以1:2比例运用PMS将两组性别、年龄、体质指数(BMI)、吸烟史、饮酒史、RHD病程、病变类型、瓣膜材料、置换位置、纽约心脏协会(NYHA)分级、基础病史等基线资料进行匹配。比较两组匹配前后的基线资料,匹配后通过多因素Logistic回归分析法分析RHD患者心脏瓣膜置换术后并发下肢DVT的危险因素。结果匹配前,两组性别、年龄、BMI、RHD病程、瓣膜材料、糖尿病史、高血脂史、心房颤动史比较,差异均有统计学意义(P<0.05),吸烟史、饮酒史、病变类型、置换位置、NYHA分级、高血压史等比较,差异均无统计学意义(P>0.05);经PSM处理后,并发组得到32例RHD患者,未并发组得到64例RHD患者,两组性别、年龄、BMI、吸烟史、饮酒史、RHD病程、病变类型、瓣膜材料、置换位置、NYHA分级、基础病史等比较差异均无统计学意义(P>0.05);匹配后,并发组术前血小板计数、D-二聚体(D-D)水平、凝血四项异常占比、三酰甘油(TG)水平、手术时长、术后当天国际标准化比值、华法林剂量、术后卧床天数均高于未并发组(P<0.05)。多因素Logistic回归分析结果显示,术前高血浆D-D水平、凝血四项异常、高血小板计数、高TG水平、长手术时长、高华法林剂量、术后长卧床天数均为RHD患者心脏瓣膜置换术后并发下肢DVT的危险因素(P<0.05);术前血浆D-D>395.25 ng/ml、血小板计数>312.22×10^(9)/L、TG>1.94 mmol/L时RHD患者心脏瓣膜置换术后并发下肢DVT的曲线下面积分别为0.799、0.777、0.813。结论经PSM均衡基线资�Objective To analyzed the risk factors of lower extremity deep vein thrombosis(DVT)after cardiac valve replacement for rheumatic heart disease(RHD)based on balance confounding factors of propensity score matching(PSM).Methods The clinical materials were retrospectively analyzed in RHD patients(n=389)undergone cardiac valve replacement in Department of Cardiac-Vascular Surgery of People’s Hospital of Anyang City from Jan.2018 to Jan.2023.The patients were divided,according to whether they complicated by lower extremity DVT or not within 1 week after the operation,into DVT group(n=35)and non-DVT group(n=354).The baseline materials were matching in a 1:2 ratio by using PMS,including gender,age,body mass index(BMI),history of smoking and drinking,RHD course,lesion type,valve material,replacement location,NAHY heart function classification and basic disease history.The baseline materials were compared between 2 groups before and after matching.After matching,the risk factors of lower extremity DVT were analyzed by using multi-factor Logistic regression analysis in RHD patients after cardiac valve replacement.Results Before matching,the differences in gender,age,BMI,RHD course,valve material and history of diabetes,hyperlipidemia and atrial fibrillation(AF)had statistical significance(P<0.05),and the differences in history of smoking and drinking,lesion type,replacement location,NYHA heart function classification and hypertension history had no statistical significance(P>0.05)between 2 groups.After PSM,there were 32 RHD patients in DVT group and 64 RHD patients in non-DVT group.The differences in gender,age,BMI,history of smoking and drinking,RHD course,lesion type,valve material,replacement location,NYHA heart function classification and basic disease history had no statistical significance(P>0.05)between 2 groups.After matching,preoperative platelet count(PLT),level of plasma D-dimer(D-D),proportion of abnormal 4 items of coagulation tests,level of triglyceride(TG),operation duration,international normalized ratio(

关 键 词：风湿性心脏病 心脏瓣膜置换术 倾向性评分匹配法 危险因素 

分 类 号：R541.2[医药卫生—心血管疾病]