肺癌根治术后发生静脉血栓栓塞症的列线图风险预测模型分析  

Analysis of column chart risk prediction model for venous thromboembolism after radical resection of lung cancer

作　　者：刘叶 王芳[2] 张怡[1] 李谈[3] Liu Ye;Wang Fang;Zhang Yi;Li Tan(Department of Thoracic Surgery,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China;Department of Respiratory and Critical Care Medicine,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China;Department of Vascular Surgery,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院胸外科,北京100020 [2]首都医科大学附属北京朝阳医院呼吸与危重症医学科,北京100020 [3]首都医科大学附属北京朝阳医院血管外科,北京100020

出　　处：《血管与腔内血管外科杂志》2024年第12期1428-1433,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨肺癌根治术后发生静脉血栓栓塞症(VTE)的列线图风险预测模型。方法收集2021年10月至2023年12月于首都医科大学附属北京朝阳医院接受肺癌根治术治疗的患者的临床资料,其中34例肺癌根治术后发生VTE的患者为VTE组,根据VTE组患者年龄、性别按1:2比例采用倾向评分匹配法从肺癌根治术后未发生VTE的患者中筛选68例设为NVTE组。将单因素分析中差异有统计学意义的因素纳入Logistic回归模型进行多因素分析,根据分析所得的危险因素或保护因素采用Nomogram构建列线图风险预测模型,采用受试者工作特征(ROC)曲线下面积(AUC)评估列线图风险预测模型的预测价值,采用Calibration内部校正曲线分析列线图风险预测模型的准确性,采用临床决策曲线分析(DCA)评估列线图的临床实用性。结果两组患者术式、手术时间、术前D-二聚体(D-D)、术后卧床时间比较,差异均有统计学意义(P﹤0.05)。肺叶切除术、手术时间≥2 h、术前D-D≥500μg/L、术后卧床时间﹥3 d为肺癌根治术后发生VTE的危险因素(P﹤0.05),据此构建的列线图风险预测模型对肺癌根治术后发生VTE的风险预测准确性良好(C指数=0.898),对肺癌根治术后发生VTE具有较高的预测价值(AUC=0.898),经DCA外部校正曲线分析具有理想的临床实用性。结论肺叶切除术、手术时间≥2 h、术前D-D≥500μg/L、术后卧床时间﹥3 d均为肺癌根治术后发生VTE的危险因素,据此构建的列线图风险预测模型对术后VTE的发生具有良好的预测价值,预测准确性与实用性均较好。Objective To investigate the risk prediction model of venous thromboembolism(VTE)after radical lung cancer surgery.Method Clinical data of patients receiving radical resection for lung cancer in Beijing Chao-yang Hospital,Capital Medical University from October 2021 to December 2023 were collected.Among them,34 patients with VTE after radical resection for lung cancer were classified as the VTE group.According to the age and gender of patients in the VTE group,1:2 proportion of patients who did not develop VTE after radical lung cancer surgery were selected by propensity matching method as NVTE group in 68 cases.The factors with statistically significant differences in the univariate analysis were incorporated into the Logistic regression model for multifactor analysis.The Nomogram risk prediction model was constructed based on the risk factors or protective factors obtained by the analysis.The predictive value of the Nomogram risk prediction model was evaluated by using the area under curve(AUC)of receiver operating characteristic(ROC).Calibration internal calibration curve was used to analyze the accuracy of the risk prediction model of the nomogram and clinical decision curve analysis(DCA)was used to evaluate the clinical practicability of the Nomogram.Result There were statistically significant differences in operation method,operation time,preoperative D-dimer(D-D)and postoperative bed time between the two groups(P<0.05).Lobectomy,operation time≥2 h,preoperative D-D≥500μg/L,and postoperative bed time>3 d were risk factors for VTE after radical lung cancer surgery(P<0.05).The risk prediction model based on the nomogram was accurate in predicting the risk of VTE after radical lung cancer surgery(C index=0.898).The nomogram risk prediction model has a high predictive value for the occurrence of VTE after radical lung cancer surgery(AUC=0.898),and the nomogram risk prediction model has ideal clinical practicability when analyzed by external correction curve of DCA.Conclusion Lobectomy,operation time≥2 h,p

关 键 词：肺癌 根治术 静脉血栓栓塞症 列线图 

分 类 号：R543[医药卫生—心血管疾病]