Logistic回归分析急性白血病患儿诱导化疗期PICC相关血栓的影响因素及防治策略

Logistic regression analysis of influencing factors and prevention and treatment strategies for PICC-related thrombosis during induction chemotherapy in children with acute leukemia

目的 采用Logistic回归分析急性白血病患儿诱导化疗期中心静脉导管(areas under the curve,PICC)相关血栓的影响因素。方法 回顾性选取急性白血病患儿184例,根据诱导化疗期(置管后15 d)导管部位超声检查是否发现血栓分为血栓组(38例)与无血栓组(146例)。收集2组临床资料,采用单因素、Logistic回归多因素分析急性白血病患儿诱导化疗期PICC相关血栓的影响因素,并采用受试者工作特征(areas under the curve,ROC)曲线评价Logistic多因素回归模型对急性白血病患儿诱导化疗期PICC相关血栓的预测价值。结果 2组年龄、性别、疾病类型、疾病危险度、置管静脉、置管时白细胞(white blood cell,WBC)、血小板计数(platelet count,PLT)、D二聚体(D dimer,D-D)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、置管后15 d WBC、PLT、PT、APTT水平比较差异无统计学意义(P>0.05);2组置管位置、合并导管相关感染、使用止血药物、置管后15 d D-D水平比较差异有统计学意义(P<0.05)。Logistic回归多因素分析,右侧置管、合并导管相关感染、使用止血药物、置管后15 d D-D水平过高是急性白血病患儿诱导化疗期PICC相关血栓的独立危险因素(P<0.05);ROC曲线分析,Logistic多因素回归模型对急性白血病患儿诱导化疗期PICC相关血栓的预测AUC为0.917,95%CI:0.866~0.954,敏感度为84.21%,特异度为84.44%。结论 急性白血病患儿诱导化疗期PICC相关血栓的独立危险因素较多,构建Logistic多因素回归模型预测价值可靠,有利于降低PICC相关血栓发生风险。

Objective To analyze the influencing factors of peripherally inserted central catheter(PICC)-related thrombosis during induction chemotherapy in children with acute leukemia by Logistic regression analysis.Methods A total of 184 children with acute leukemia were retrospective selected.According to the presence or absence of thrombosis at the catheter site during induction chemotherapy period(at 15 d after catheter placement),they were divided into thrombus group(n=38)and the non-thrombosis group(n=146).The clinical data of the two groups were collected,and univariate and multivariate Logistic regression analyses were used to analyze the influencing factors of PICC-related thrombosis during induction chemotherapy in children with acute leukemia.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of multivariate Logistic regression model in PICC-related thrombosis in children with acute leukemia during induction chemotherapy.Results There was no significant difference between two groups in age,sex,disease type,disease risk,vein catheterization,as well as white blood cell(WBC),platelet(PLT),D-dimer(D-D),prothrombin time(PT),and activated partial thromboplastin time(APTT)at the time of catheterization,and WBC,PLT,PT and APTT at 15 d after catheterization(P>0.05).There were significant differences in catheter placement,catheter-related infection,use of hemostatic drugs and D-D level at 15 d after catheterization between two groups(P<0.05).Multivariate Logistic regression analysis showed that right-sided catheterization,catheter-related infection,use of hemostatic drugs,and high D-D level at 15 d after catheterization were independent risk factors for PICC-related thrombosis in children with acute leukemia during induction chemotherapy(P<0.05).ROC curve analysis showed that the area under the ROC curve(AUC)of multivariate Logistic regression model in predicting PICC-related thrombosis in children with acute leukemia during induction chemotherapy was 0.917,95%CI was 0.866 to 0.954,sensitivity was 84.21%,and specificity was 84.44%.Conclusion There are a number of independent risk factors for PICC-related thrombosis during induction chemotherapy in children with acute leukemia.Multivariate Logistic regression model has a reliable predictive value,which is conductive to reduction of the risk of PICC-related thrombosis.