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中青年髋部骨折患者术前深静脉血栓形成的危险因素及列线图预测模型的构建

Risk factors of preoperative deep venous thrombosis in young and middle-aged patients with hip fracture and construction of a Nomogram predictive model

    摘要
  • 摘要:
    目的 分析中青年髋部骨折患者术前深静脉血栓形成(DVT)的危险因素，并构建列线图预测模型。
    方法 选取首次确诊髋部骨折的中青年患者共408例，根据术前双功能彩色多普勒超声检查(DUS)结果分为DVT组60例和无DVT组348例。比较2组临床资料和血生化指标; 采用多因素Logistic回归分析筛选危险因素，并构建列线图模型。
    结果 单因素分析发现，相比于无DVT组, DVT组年龄更大，低能量损伤增多，受伤至DUS时间和总住院时间延长，血清总蛋白 < 60 g/L、白蛋白 < 35 g/L、乳酸脱氢酶(LDH)≥250 U/L、红细胞(RBC)计数 < 4.0×1012/L、血红蛋白(Hb) < 110 g/L、红细胞压积(HCT)≥50%、血小板计数≥300.0×109/L和D-二聚体≥0.5 mg/L的患者比率较高，差异均有统计学意义(P < 0.05)。多因素Logistic回归分析显示，年龄大、受伤至DUS时间长、LDH≥250 U/L、D-二聚体≥0.5 mg/L和HCT≥50%是术前DVT发生的独立危险因素(P < 0.05)。采用R软件建立列线图模型，总分220分。受试者工作特征(ROC)曲线计算列线图预测DVT的曲线下面积(AUC)为0.897, 大于各单一危险因素的AUC, 差异有统计学意义(P < 0.05)。Hosmer-Lemeshow检验显示，列线图的拟合优度良好(χ2=1.625, P=0.342)。校正曲线显示，列线图预测DVT的发生概率与实际DVT发生率有较好的一致性。
    结论 中青年髋部骨折患者也有一定的术前DVT发生率，年龄大、受伤至DUS时间长、LDH≥250 U/L、D-二聚体≥0.5 mg/L和HCT≥50%是影响术前DVT发生的独立危险因素。构建列线图模型用于指导术前筛查高风险DVT患者有较好的应用潜力。

     

    Abstract:
    Objective To analyze the risk factors of preoperative deep venous thrombosis (DVT) in young and middle-aged patients with hip fracture, and to construct a Nomogram predictive model.
    Methods A total of 408 young and middle-aged patients firstly diagnosed as hip fracture were selected, and they were divided into DVT group with 60 cases and no DVT group with 348 cases according to the result of preoperative dual functional color Doppler ultrasonography (DUS). Clinical materials and blood biochemical indicators were compared between two groups; the multivariate Logistic regression analysis was used to screen risk factors, and a Nomogram model was established.
    Results Single factor analysis showed that when compared to the no DVT group, the age was older, the low energy injury increased, the time from injury to DUS and the total hospital stay prolonged, the ratios of patients with total serum protein < 60 g/L, albumin < 35 g/L, lactate dehydrogenase (LDH) ≥250 U/L, the red blood cell (RBC) count < 4.0×1012/L, hemoglobin (Hb) < 110 g/L, hematocrit (HCT) ≥50%, platelet count ≥300.0×109/L and D-dimer ≥0.5 mg/L in the DVT group were higher, and all these differences were statistically significant (P < 0.05). Multivariate Logistic regression analysis showed that older age, longer time from injury to DUS, LDH ≥250 U/L, D-dimer ≥0.5 mg/L and HCT ≥50% were the independent risk factors for preoperative DVT (P < 0.05). R software was used to establish the Nomogram model, with a total score of 220 points. The area under thecurve (AUC) of the Nomogram for predicting DVT by receiver operating characteristic (ROC) curve was 0.897, which was significantly larger than that of each single risk factor (P < 0.05). The Hosmer-Lemeshow test showed that the goodness of fit of the Nomogram was good (χ2=1.625, P=0.342). The correction curve showed that the predicted probability of DVT by the Nomogram was consistent with the actual incidence of DVT.
    Conclusion Young and middle-aged patients with hip fracture have a certain incidence rate of preoperative DVT, and older age, longer time from injury to DUS, LDH ≥250 U/L, D-dimer ≥0.5 mg/L and HCT ≥50% are the independent risk factors affecting the occurrence of preoperative DVT. The established Nomogram model shows a good application potential for guiding preoperative screen of patients with high-risk DVT.

     

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