肝硬化门静脉高压症脾切除术后发生PVT风险的预测模型
发布时间：2018-07-15 09:11
【摘要】：目的：探讨肝硬化门静脉高压症脾切除术后门静脉血栓(portal venous system thrombosis PVT)形成危险因素并建立Logistic回归预测模型,评价该模型对于判断脾切除术后形成PVT的预测价值。方法：收集新疆医科大学第一附属医院2009-01-01/2013-12-31期间因肝硬化门静脉高压导致脾功能亢进和/或食道胃底静脉曲张行脾切除术治疗患者的围手术期临床资料,以术后2周是否发生PVT为标准分组,对围术期相关临床危险因素进行单因素分析和多因素Logistic回归分析,根据多因素分析结果建立Logistic回归预测模型,绘制术后2周PVT形成风险情况的ROC曲线,评价该模型对于判断术后形成PVT风险的预测价值。结果：多因素结果分析显示术后5-7天血小板计数(PLT)、血小板体积(mean platelet volume MPV)、D-二聚体(D-Dimer)为术后2周患者发生PVT的独立危险因素,术后使用抗凝药物(usage of anticoagulation therapy UAT)、术后使用降低门静脉压力药物(usage of reducing portal pressure therapy URPT)为术后2周患者发生PVT的独立保护因素,根据上述指标建立Logistic回归预测模型：Logit P=-9.165+0.664×PLT (×1011/L)+0.413× MPV (fL)+0.662×D-Dimer (mg/L)-1.674×UAT(是=1,否=0)-1.518×URPT(是=1,否=0),界值为-1.14,ROC曲线下的面积为0.865,准确度为84.03%,而方程中的各独立危险因素PLT、MPV、D-Dimer所对应的界值点分别为4.42×1011/L、13.30 fL、2.55mg/L。结论：本项研究得出脾切除术后5-7天当PLT≥4.42×1011/L、MPV≥ 13.30fL、D-Dimer≥2.55mg/L将明显增加PVT发生风险,术后UAT和URPT可以有效减少PVT的发生,对判断肝硬化脾切除术后2周形成PVT的风险建立了准确性达到84.03%的预测模型,该模型灵敏度、特异度、准确度高,我们的模型对于围术期选择合理的干预方法预防PVT形成提供了明确的数学模型及临界值,进一步验证其准确性具有重要的临床意义和价值。
[Abstract]:Objective: to investigate the risk factors of portal hypertension in patients with cirrhosis after splenectomy and to establish a logistic regression model to evaluate the predictive value of the model in predicting the formation of (portal venous system thrombosis after splenectomy. Methods: the perioperative clinical data of patients with hypersplenism and / or esophageal varices caused by cirrhosis and portal hypertension during 2009-01-01 / 2013-12-31 in the first affiliated Hospital of Xinjiang Medical University were collected. According to whether PVT occurred at 2 weeks after operation, univariate analysis and multivariate logistic regression analysis were used to analyze the clinical risk factors in perioperative period, and a logistic regression prediction model was established according to the results of multivariate analysis. The ROC curve of PVT formation risk was drawn 2 weeks after operation, and the predictive value of the model for predicting the risk of PVT formation was evaluated. Results: multivariate analysis showed that platelet count (PLT), platelet volume (mean platelet volume) and D-Dimer (D-Dimer) were independent risk factors of PVT in patients 2 weeks after operation. Postoperative anticoagulant (usage of anticoagulation therapy) and postoperative portal vein pressure reduction drug (usage of reducing portal pressure therapy UAT) were the independent protective factors for the occurrence of PVT 2 weeks after operation. According to the above indexes, a Logistic regression prediction model was established, logit Pfi-9.165 脳 PLT (脳 1011 / L) 0.413 脳 MPV (fL) 0.662 脳 D-Dimer (mg / L) -1.674 脳 UAT (is 1, 0) -1.518 脳 URPT (is 1, 0), the boundary value is -1.14 ~ (-1) ROC curve, the area under the curve is 0.865, the accuracy is 84.03, and the bound point of the independent risk factor PLTT MPV D-Dimer in the equation is 4.42 脳 1011L 13.30 fl ~ (-1) mg 路L ~ (-1) L = 2.55 mg 路L ~ (-1) 路L ~ (-1), respectively. Conclusion: 5-7 days after splenectomy, PLT 鈮，
本文编号：2123556
[Abstract]:Objective: to investigate the risk factors of portal hypertension in patients with cirrhosis after splenectomy and to establish a logistic regression model to evaluate the predictive value of the model in predicting the formation of (portal venous system thrombosis after splenectomy. Methods: the perioperative clinical data of patients with hypersplenism and / or esophageal varices caused by cirrhosis and portal hypertension during 2009-01-01 / 2013-12-31 in the first affiliated Hospital of Xinjiang Medical University were collected. According to whether PVT occurred at 2 weeks after operation, univariate analysis and multivariate logistic regression analysis were used to analyze the clinical risk factors in perioperative period, and a logistic regression prediction model was established according to the results of multivariate analysis. The ROC curve of PVT formation risk was drawn 2 weeks after operation, and the predictive value of the model for predicting the risk of PVT formation was evaluated. Results: multivariate analysis showed that platelet count (PLT), platelet volume (mean platelet volume) and D-Dimer (D-Dimer) were independent risk factors of PVT in patients 2 weeks after operation. Postoperative anticoagulant (usage of anticoagulation therapy) and postoperative portal vein pressure reduction drug (usage of reducing portal pressure therapy UAT) were the independent protective factors for the occurrence of PVT 2 weeks after operation. According to the above indexes, a Logistic regression prediction model was established, logit Pfi-9.165 脳 PLT (脳 1011 / L) 0.413 脳 MPV (fL) 0.662 脳 D-Dimer (mg / L) -1.674 脳 UAT (is 1, 0) -1.518 脳 URPT (is 1, 0), the boundary value is -1.14 ~ (-1) ROC curve, the area under the curve is 0.865, the accuracy is 84.03, and the bound point of the independent risk factor PLTT MPV D-Dimer in the equation is 4.42 脳 1011L 13.30 fl ~ (-1) mg 路L ~ (-1) L = 2.55 mg 路L ~ (-1) 路L ~ (-1), respectively. Conclusion: 5-7 days after splenectomy, PLT 鈮，
本文编号：2123556
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