Risk factors for post-thrombotic syndrome after removal of lower extremity deep vein thrombosis
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摘要: 目的 分析下肢深静脉血栓清除后血栓后综合征(post-thrombotic syndrome，PTS)的危险因素，并构建PTS的列线图(nomogram)预测模型。方法 选取2019年10月-2021年11月太仓市第一人民医院接诊并治疗的166例下肢深静脉血栓患者为研究对象，根据Villalta评分将患者分为PTS组(48例)和非PTS组(118例)。比较两组患者的一般资料，采用受试者工作特征(receiver operating characteristic，ROC)曲线实验分析有统计学意义的连续性变量的预测价值，采用logistic回归实验分析下肢深静脉血栓清除后PTS的危险因素，采用内部数据验证nomogram模型临床效能。结果 与非PTS组比较，PTS组患者BMI较高、病程较长，血栓清除分级Ⅰ/Ⅱ级占比、静脉曲张占比较高，差异有统计学意义(P < 0.05)；BMI、病程的曲线下面积为0.694、0.757，最佳截断值为24.08 kg/m2、14 d；BMI(>24.08 kg/m2)、病程(>14 d)、血栓清除分级(Ⅰ/Ⅱ级)、静脉曲张(是)是影响下肢深静脉血栓清除后PTS的危险因素(P < 0.05)；nomogram模型预测下肢深静脉血栓清除后PTS的风险C-index为0.880(0.822~0.939)；模型预测下肢深静脉血栓清除后PTS的风险阈值>0.07。结论 BMI(>24.08 kg/m2)、病程(>14 d)、血栓清除分级(Ⅰ/Ⅱ级)、静脉曲张(是)是影响下肢深静脉血栓清除后PTS的危险因素，且基于以上变量构建的nomogram模型有较好的预测价值，尽早监测及早期预防，可以最大限度降低PTS的发生概率。
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关键词:
- 下肢深静脉血栓 /
- 血栓后综合征 /
- 危险因素 /
- nomogram预测模型
Abstract: Objective To analyse the risk factors for post-thrombotic syndrome(PTS) after removal of lower limb deep vein thrombosis and to construct a nomogram prediction model for PTS.Methods One hundred and sixty-six patients with lower limb deep vein thrombosis who came to our hospital and were treated from October 2019 to November 2021 were selected for the study, and the patients were divided into PTS group(n=48) and no PTS group(n=118) according to Villalta score. The general data of the patients in the two groups were compared. The predictive value of statistically significant continuous variables was analysed by the receiver operating characteristic curve(ROC) test. The risk factors for PTS after removal of lower limb DVT were analysed by the logistic regression test. And the clinical efficacy of the nomogram model was verified using internal data.Results Compared with the non-PTS group, patients in the PTS group had higher BMI, longer disease duration, higher percentage of thrombus clearance grade Ⅰ/Ⅱ, and higher percentage of varicose veins(P < 0.05). The area under curve of BMI and disease duration were 0.694 and 0.757, and the best cut-off values were 24.08 kg/m2 and 14 days. BMI(>24.08 kg/m2), disease duration(>14 days), thrombus clearance grade(grade Ⅰ/Ⅱ), and varicose veins(yes) were risk factors affecting post-thrombotic syndrome after lower extremity deep vein thrombosis clearance(P < 0.05). The nomogram model predicted a risk C-index of 0.880(0.822-0.939) for post-thrombotic syndrome after lower extremity deep vein thrombosis clearance. The model predicted a risk threshold for post-thrombotic syndrome after lower extremity deep vein thrombosis clearance >0.07.Conclusion BMI(>24.08 kg/m2), disease duration(>14 days), thrombus clearance grade(grade Ⅰ/Ⅱ), and varicose veins(yes) are risk factors affecting post-thrombotic syndrome after lower extremity deep vein thrombus clearance, and the nomogram model constructed based on the above variables have good predictive value. Early monitoring and early prevention minimize the probability of PTS to the maximum. -
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表 1 两组临床资料比较
X±S 项目 PTS组(48例) 非PTS组(118例) t/χ2 P 年龄/岁 60.50±2.20 60.20±2.80 0.724 0.470 性别/例(%) 1.802 0.180 男 23(47.92) 70(59.32) 女 25(52.08) 48(40.68) BMI/(kg/m2) 24.05±3.20 22.20±2.10 3.708 < 0.001 糖尿病/例(%) 0.047 0.828 是 5(10.42) 11(9.32) 否 43(89.58) 107(90.68) 高血压/例(%) 0.179 0.672 是 15(31.25) 33(27.97) 否 33(68.75) 85(72.03) 病程/d 14.50±2.80 12.05±1.95 5.541 < 0.001 患肢/例(%) 0.078 0.780 左侧 30(62.50) 71(60.17) 右侧 18(37.50) 47(39.83) 血栓清除分级/例(%) 13.178 < 0.001 Ⅰ/Ⅱ级 27(56.25) 98(83.05) Ⅲ级 21(43.75) 20(16.95) 髂骨静脉血栓/例(%) 1.775 0.183 是 39(81.25) 105(88.98) 否 9(18.75) 13(11.02) 合并肿瘤/例(%) 0.024 0.878 是 4(8.33) 9(7.63) 否 44(91.67) 109(92.37) 小腿肌间血栓/例(%) 0.217 0.642 是 21(43.75) 47(39.83) 否 27(56.25) 71(60.17) 静脉曲张/例(%) 6.718 0.010 是 17(35.42) 20(16.95) 否 31(64.58) 98(83.05) 治疗方式/例(%) 0.336 0.953 下肢静脉置管溶栓 11(22.92) 25(21.19) 经皮机械血栓清除术 10(20.83) 22(18.64) 髂静脉球囊扩张和支架植入术 17(35.42) 42(35.59) 柑橘黄酮片 10(20.83) 29(24.58) 
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表 2 相关变量ROC曲线分析结果
变量 AUC 最佳截断值 Youden指数 SE 95%CI P 灵敏度/% 特异度/% BMI 0.694 24.08 kg/m2 0.443 0.053 0.617~0.763 < 0.001 60.42 83.90 病程 0.757 14 d 0.365 0.042 0.685~0.820 < 0.001 45.83 90.68
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表 3 影响下肢深静脉血栓清除后PTS的危险因素分析
模型 β SE Wald P OR 95%CI BMI(>24.08 kg/m2 vs. ≤24.08 kg/m2) 0.505 0.157 10.346 < 0.001 1.657 1.252~3.051 病程(>14 d vs. ≤14 d) 0.752 0.209 12.946 < 0.001 2.122 1.589~3.541 血栓清除分级(Ⅰ/Ⅱ级vs. Ⅲ级) 0.358 0.112 10.217 < 0.001 1.430 1.159~2.698 静脉曲张(是vs. 否) 0.376 0.128 8.629 0.002 1.457 1.228~2.969
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[1] 张杰, 刘大方, 赵辉, 等左髂静脉压迫并发急性左髂股静脉血栓形成的综合治疗[J]. 中华普通外科杂志, 2020, 35(2): 120-123. https://www.cnki.com.cn/Article/CJFDTOTAL-XFXZ201811016.htm
[2] 邓亮. 静脉内置管溶栓联合下腔静脉滤器和单纯抗凝溶栓治疗下肢深静脉血栓的近期疗效[J]. 智慧健康, 2021, 7(36): 74-76. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHJK202136025.htm
[3] Visonà A, Quere I, Mazzolai L, et al. Post-thrombotic syndrome[J]. Vasa, 2021, 50(5): 331-340. doi: 10.1024/0301-1526/a000946
[4] 孙明胜, 孙聪睿, 王盛兴, 等. 髂静脉受压综合征腔内治疗的临床疗效[J]. 血管与腔内血管外科杂志, 2023, 9(4): 399-401, 429. https://www.cnki.com.cn/Article/CJFDTOTAL-XGQW202304003.htm
[5] 李晓强, 冉峰. 提高血栓形成后综合征腔内治疗的远期效果[J]. 中华血管外科杂志, 2018, 3(4): 195-197.
[6] Urbanek T, Labropoulos N. Can we predict and prevent the postthrombotic syndrome?[J]. Vasa, 2021, 50(1): 11-21. doi: 10.1024/0301-1526/a000932
[7] 史振宇, 杨涛, 吴丹明. 下肢静脉阻塞性疾病相关指南与共识解读[J]. 中国实用外科杂志, 2022, 42(12): 1364-1366. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK202212005.htm
[8] Qiu P, Liu J, Wan F, et al. A predictive model for postthrombotic syndrome in proximal deep vein thrombosis patients[J]. Ann Transl Med, 2021, 9(7): 558.
[9] Ning J, Ma W, Fish J, et al. Biases of Villalta scale in classifying post-thrombotic syndrome in patients with pre-existing chronic venous disease[J]. J Vasc Surg Venous Lymphat Disord, 2020, 8(6): 1025-1030.
[10] 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第三版)[J]. 中国血管外科杂志(电子版), 2017, 9(4): 250-257. https://www.cnki.com.cn/Article/CJFDTOTAL-XGWK201704005.htm
[11] Li R, Yuan M, Cheng J, et al. Risk of post-thrombotic syndrome after deep vein thrombosis treated with rivaroxaban versus vitamin-K antagonists: A systematic review and meta-analysis[J]. Thromb Res, 2020, 196: 340-348.
[12] Makris M, Pavord S. Most cases of Thrombosis and Thrombocytopenia Syndrome(TTS)post ChAdOx-1 nCov-19 are Vaccine-induced Immune Thrombotic Thrombocytopenia(VITT)[J]. Lancet Reg Health Eur, 2021, 12: 100274.
[13] 张应战, 赵群, 蔡超, 等. 血管内支架治疗髂股静脉血栓形成后综合征的疗效分析[J]. 蚌埠医学院学报, 2021, 46(7): 933-936. https://www.cnki.com.cn/Article/CJFDTOTAL-BANG202107024.htm
[14] 张桂凌, 肖影, 张洁, 等. 基于医院的延续性护理模式对静脉血栓栓塞症术后患者近期预后及遵医行为的影响[J]. 临床心身疾病杂志, 2023, 29(04): 146-151. https://www.cnki.com.cn/Article/CJFDTOTAL-LCSX202304027.htm
[15] 杜鑫, 贾文斌, 刘唯棕, 等. 下肢深静脉血栓后综合征相关危险因素研究进展[J]. 中华老年多器官疾病杂志, 2021, 20(12): 936-939. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLQG202112014.htm
[16] 汪涛, 范隆华, 刘坚军, 等. 下肢深静脉血栓后综合征患者中静脉支架的中期通畅率及高危因素回归分析[J]. 复旦学报(医学版), 2022, 49(03): 339-344. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYK202203004.htm
[17] 邢越, 徐国建, 朱峥嵘, 等. 介入手术与抗凝治疗急性下肢静脉血栓形成的疗效对比[J]. 岭南现代临床外科, 2021, 21(1): 126-129, 133. https://www.cnki.com.cn/Article/CJFDTOTAL-LNWK202101025.htm
[18] 胡明, 覃晓, 杨晗, 等. 急性期与亚急性期下肢深静脉血栓治疗效果相关因素分析[J]. 中国临床医生杂志, 2022, 50(5): 597-599. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYS202205029.htm
[19] 徐淼, 张喜成, 陈兆雷, 等. 大腔导管手动抽吸和经皮机械血栓清除术治疗髂静脉闭塞继发髂股静脉血栓形成的比较[J]. 中国普通外科杂志, 2021, 30(6): 663-669. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWZ202106005.htm
[20] 叶琨, 万圣云, 丁洋. AngioJet吸栓联合支架植入治疗急性下肢深静脉血栓形成合并髂静脉狭窄的短期疗效[J]. 中国血管外科杂志(电子版), 2020, 12(4): 314-318. https://www.cnki.com.cn/Article/CJFDTOTAL-XGWK202004013.htm
[21] 王为华. 机械性血栓清除术对急性下肢深静脉血栓形成患者近远期治疗效果及临床预后的影响[J]. 中国实用医药, 2023, 18(10): 41-45. . https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA202310009.htm
[22] 杜鑫, 贾文斌, 刘唯棕, 等. 下肢深静脉血栓后综合征相关危险因素研究进展[J]. 中华老年多器官疾病杂志, 2021, 20(12): 936-939. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLQG202112014.htm
[23] 汪涛, 范隆华, 刘坚军, 等. 下肢深静脉血栓后综合征患者中静脉支架的中期通畅率及高危因素回归分析[J]. 复旦学报(医学版), 2022, 49(3): 339-344. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYK202203004.htm
[24] Lin Z, Mi B, Liu X, et al. nomogram for Predicting Deep Venous Thrombosis in Lower Extremity Fractures[J]. Biomed Res Int, 2021, 2021: 9930524.
[25] Xing Y, Tian Z, Jiang Y, et al. A practical nomogram based on systemic inflammatory markers for predicting portal vein thrombosis in patients with liver cirrhosis[J]. Ann Med, 2022, 54(1): 302-309.
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