骨盆骨折后术前下肢深静脉血栓形成预测模型探讨

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摘要目的〓研究骨盆骨折后术前下肢深静脉血栓(deep vein thrombosis，DVT)形成的危险因素，并探讨列线图预测模型。方法〓回顾性分析2017年1月至2022年1月就诊(受伤24 h内)并收入急诊重症监护病房的骨盆骨折患者665例。根据患者就诊即刻血糖、糖化血红蛋白(hemoglobin A1c，HbA1c)计算应激性血糖升高比值(stress hyperglycemia ratio，SHR)。根据是否发生下肢DVT分为血栓组和非血栓组，血栓组236例，其中男165例，女71例；年龄18~89岁，中位年龄56岁。非血栓组429例，其中男312例，女117例；年龄19~92岁，中位年龄49岁。比较两组人口学特征、实验室指标、创伤严重程度评分(injury severity score，ISS)等资料；采用Logistic回归分析筛选血栓组的危险因素；采用受试者工作曲线(receiver operating characteristic curve，ROC)分析危险因素对下肢DVT患者的预测价值。结果〓血栓组与非血栓组在年龄、ISS、血红蛋白、血小板、白蛋白、血糖、SHR、24 h红悬输血量及住院天数方面，差异有统计学意义(P＜0.05)。Logistic回归分析显示，50~69岁(OR=2.02，95%CI：1.40~2.95，P＜0.001)、70岁以上(OR=4.74，95%CI：2.57~8.97，P＜0.001)、ISS(OR=1.57，95%CI：1.11~2.23，P＝0.012)、血红蛋白100~124 g/L(OR=0.53，95%CI：0.36~0.80，P＝0.002)、血红蛋白＞124 g/L(OR=0.32，95%CI：0.21~0.50，P＜0.001)、SHR(OR=1.64，95%CI：1.12~2.41，P＝0.011)是下肢DVT发生的独立危险因素。ROC曲线分析显示，年龄、ISS、血红蛋白及SHR预测下肢DVT的ROC曲线下面积(area under curve，AUC)分别为0.63、0.59、0.64、0.57，总面积为0.72。将上述危险因素纳入列线图模型，AUC和自举法内部验证后模型预测结果与实际结果一致。结论〓年龄、ISS、血红蛋白及SHR是骨盆骨折患者术前下肢DVT形成的独立危险因素。基于logistic回归模型建立的列线图预测模型对骨盆骨折术前下肢DVT发生有较好的预测效能。

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	李永霞
	姜家梅
	侍冬成
	吴蔚
	朱晓光
	封启明

关键词 ：应激性血糖升高比值, 骨盆骨折, 下肢深静脉血栓, 列线图

Abstract：Objective〓To investigate the risk and prognostic factors of deep vein thrombos(DVT) is in pelvic fracture patients before surgery and to develop a nomogram model to predict the risk of DVT.Methods〓A retrospective observational study was conducted，including 665 patients hospitalized in the emergency intensive care unit(EICU) with pelvic fractures from January 2017 to January 2022.The value of stress hyperglycemia ratio(SHR) was calculated based on the patient’s immediate blood glucose and hemoglobin A1c(HbA1c).According to the results of ultrasound examination，the subjects were divided into DVT group and non-DVT group.There were 236 patients in the DVT group，including 165 males and 71 females，aged from 18 to 89 years old，with an median age of 56 years old.There were 429 patients in the non-DVT group，including 312 males and 117 females，aged from 19 to 92 years old，with an median age of 49 years old.The differences of demographic characteristics，laboratory indicators，injury severity score(ISS) and other data were compared.Logistic regression analysis was used to screen for risk factors in the DVT group.Logistic regression analysis was applied to identify independent risk factors for DVT after pelvic fracture.Receiver operating characteristic(ROC) curve was used to analyze the predictive the clinical value of those parameters to predict preoperative DVT.Results〓Significant differences were observed between the DVT and non-DVT groups in age，ISS，hemoglobin，platelet，albumin，blood glucose，SHR，the 24-hour RBC transfusion volume and length of hospital stay(P＜0.05).Logistic regression analysis revealed that the following factors were independent risk factors for DVT：Age between 50 and 69 years (OR=2.02，95%CI：1.4~2.95，P＜0.001)，age over 70 years (OR=4.74，95%CI：2.57~8.97，P＜0.001)，ISS (OR=1.57，95% CI：1.11~2.23，P＝0.012)，hemoglobin levels of 100~124 g/L (OR=0.53，95% CI：0.36~0.80，P＝0.002)，hemoglobin levels over 124 g/L (OR=0.32，95% CI：0.21~0.50，P＜0.001)，and SHR (OR=1.64，95% CI：1.12~2.41，P＝0.011).ROC curve analysis demonstrated that the area under the ROC curve (AUC) for age，ISS，hemoglobin，and SHR in predicting DVT were 0.63，0.59，0.64，and 0.57，respectively，with an overall AUC of 0.72.A predictive nomogram model was constructed using these identified risk factors.The calibration chart of the model indicated a good agreement between the predicted probability and the actual occurrence probability，and decision curve analysis confirmed the nomogram’s ability to predict the risk of DVT.Conclusion〓 Age，ISS，hemoglobin levels，and SHR are independent risk factors for DVT in preoperative pelvic fracture patients.The nomogram prediction model，based on logistic regression，exhibits good predictive efficacy for DVT in this patient population.

Key words： stress-induced hyperglycemia pelvic fracture deep venous thrombosis nomogram

基金资助:上海申康医院发展中心临床研究项目(SHDC22021211)
上海市第六人民医院院级课题(ynhg202311)

通讯作者: 封启明

作者简介: 李永霞(1985－ )，女，主治医师，上海交通大学医学院附属第六人民医院急诊医学科，szp219@163.com。

引用本文:

李永霞，姜家梅，侍冬成，吴蔚，朱晓光，封启明. 骨盆骨折后术前下肢深静脉血栓形成预测模型探讨[J]. 实用骨科杂志, 2024, 30(3): 217-.
Li Yongxia，Jiang Jiamei，Shi Dongcheng，Wu Wei，Zhu Xiaoguang，Feng Qiming. A Prognostic Nomogram Model to Predict Deep Vein Thrombosis in Preoperative Pelvic Fracture Patients. sygkzz, 2024, 30(3): 217-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2024/V30/I3/217

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