起搏器植入术后深静脉血栓形成的Nomograms预测模型研究

Nomograms prediction model of deep venous thrombosis after pacemaker implantation

目的通过建立Nomograms预测模型分析起搏器植入术后深静脉血栓形成的危险因素。方法收集2019年1月至2022年1月于秦皇岛市第一医院245例进行永久起搏器植入术患者的临床资料,根据深静脉血栓形成情况将患者分为发生深静脉血栓组(n=42)与未发生深静脉血栓组(n=203)。分析起搏器植入术后深静脉血栓形成的危险因素,构建Nomograms模型,通过受试者工作特征(ROC)曲线评估列线图模型对起搏器植入术后深静脉血栓形成的预测价值并进行内部验证。结果单因素分析结果显示,两组患者的年龄、体重指数、吸烟史、合并糖尿病情况、恶性肿瘤患病情况、心房颤动病史、心功能分级、手术时间、术后制动时间、术后感染情况、D二聚体水平比较,差异均有统计学意义(P﹤0.05);两组患者的性别、高血压、冠心病、动脉粥样硬化、术后抗血小板治疗、术后抗凝治疗、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、凝血酶原时间(PT)比较,差异均无统计学意义(P﹥0.05)。多因素分析结果显示,体重指数高、合并糖尿病、合并恶性肿瘤、合并心房颤动、心功能分级为Ⅲ~Ⅳ级、术后制动时间长、有术后感染均是起搏器植入术后深静脉血栓形成的独立危险因素(P﹤0.05)。ROC曲线分析结果显示,列线图模型预测起搏器植入术后深静脉血栓形成的曲线下面积为0.935(95%CI:0.887~0.984,P﹤0.05),区分度较好。内部验证结果显示,模型表现与理想模型基本拟合,提示模型预测的准确度较高。结论体重指数高、合并糖尿病、合并恶性肿瘤、合并心房颤动、心功能分级为Ⅲ~Ⅳ级、术后制动时间长、有术后感染均是起搏器植入术后深静脉血栓形成的独立危险因素,Nomograms模型对于起搏器植入术后深静脉血栓形成的预测具有较高的准确度与区分度。

Objective To explore the risk factors of deep venous thrombosis after pacemaker implantation by establishing a Nomograms prediction model.Method Clinical data of 245 patients who underwent permanent pacemaker implantation in the First Hospital of Qinhuangdao City from January 2019 to January 2022 were collected,and the patients were divided into the deep venous thrombosis group(n=42)and the non-deep venous thrombosis group(n=203)according to the condition of deep venous thrombosis.The risk factors of deep venous thrombosis after pacemaker implantation were analyzed,the Nomograms model was constructed and the value of Nomograms in predicting postoperative deep venous thrombosis after pacemaker implantation by receiver operating characteristic(ROC)curve and internal validation was performed.Result The results of univariate analysis showed that there were significant differences for the age,body mass index,smoking history,diabetes,malignancies,atrial fibrillation history,cardiac function grading,operation time,postoperative braking time,postoperative infection,and D-dimer level(P<0.05);there was no significant difference for the gender,hypertension,coronary heart disease,atherosclerosis,postoperative antiplatelet therapy,postoperative anticoagulation therapy,activated partial thromboplastin time(APTT),international normalized ratio(INR)and prothrombin time(PT)between two groups(P>0.05).The results of multivariate analysis showed that high body mass index,concomitant diabetes,concomitant malignant tumor,concomitant atrial fibrillation,cardiac function grade III-IV,long postoperative braking time and postoperative infection were risk factors for deep venous thrombosis after pacemaker implantation(P<0.05).ROC curve analysis results showed that the area under the curve predicted by the Nomograms prediction model for deep venous thrombosis after pacemaker implantation was 0.935(95%CI:0.887-0.984,P<0.05),with superior discrimination.The internal validation results show that the performance of the model is basically consistent with the ideal model,suggesting that the accuracy of the model prediction is high.Conclusion High body mass index,concomitant diabetes,concomitant malignant tumor,concomitant atrial fibrillation,cardiac function grade III-IV,long postoperative braking time and postoperative infection are independent risk factors for deep venous thrombosis after pacemaker implantation,the Nomograms model has high discrimination and accuracy for the prediction of deep venous thrombosis after pacemaker implantation.