摘要
目的筛选康北高原慢性阻塞性肺疾病急性加重患者发生静脉血栓栓塞症风险的预测因素,建立AECOPD发生VTE风险的联合预测模型并分析其预测效能。方法选择2018年1月-2022年9月因慢性阻塞性肺疾病急性加重在甘孜县人民医院住院治疗的患者71例,根据是否发生VTE分为血栓组35例,对照组36例。收集患者的基本资料和检查、检验资料等相关参数数据,选出两组之间具有显著差异的指标。将上述单因素分析中有显著差异的指标纳入多因素分析,筛选出AECOPD发生VTE风险的独立影响因素,并构建预测模型。利用受试者工作特征(receiver operating characteristic,ROC)曲线评价各独立因素及预测模型的应用价值,计算曲线下面积及其敏感度与特异度,分析其预测效能,霍斯默-莱梅肖检验评价拟合度。结果单因素分析显示血栓组PPS评分、乳酸脱氢酶(LDH)、D-二聚体、降钙素原(PCT)均高于对照组(均P<0.05)。Logistic回归分析显示PPS评分、乳酸脱氢酶(LDH)、D-二聚体为AECOPD发生VTE的独立预测因素。三者联合构建的预测模型曲线下面积(area under curve,AUC)为0.944(95%CI:0.893~0.996),灵敏度、特异度均明显优于各单一指标(灵敏度为94.3%、特异度为83.3%),霍斯默-莱梅肖检验拟合度好(χ^(2)=11.915,P=0.155)。结论PPS评分、乳酸脱氢酶(LDH)、D-二聚体可能是预测康北高原AECOPD发生VTE的因素,且三者联合构建的预测模型对VTE风险预测具有很好效能,可为预测AECOPD发生VTE的风险提供参考。
Objective To screen the risk factors for predicting venous thromboembolism(VTE)risk in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in Kangbei plateau,so as to establish a joint prediction model for the risk of VTE in AECOPD and analyze its predictive efficiency.Methods From January 2018 to September 2022,71 patients with AECOPD hospitalized in Ganzi County People′s Hospital were selected and divided into the thrombosis group(n=35)and the control group(n=36)according to whether VTE occurred.The basic data of patients,examination and test data and other relevant parameter data were collected,and the indicators with significant differences between the two groups were selected.The indicators with significant differences in the above univariate analysis were included in the multivariate analysis to screen out the independent influencing factors of the risk of VTE in AECOPD,and the prediction model was constructed.The receiver operating characteristic(ROC)curve was used to evaluate the independent factors and the application value of the prediction model.The area under the curve,its sensitivity and specificity were calculated,and the prediction efficiency was analyzed.The Hosmer-Lemeshaw test was used to evaluate the degree of fit.Results Univariate analysis showed that PPS score,lactate dehydrogenase(LDH),D-dimer and procalcitonin(PCT)in the thrombus group were higher than those in the control group(all P<0.05).Logistic regression analysis showed that PPS score,lactate dehydrogenase(LDH)and D-dimer score were independent predictors of VTE in AECOPD.The area under curve(AUC)of the prediction model jointly constructed by the three factors was 0.944(95%CI:0.893-0.996),the sensitivity and specificity were significantly better than those of each single index(sensitivity was 94.3%,specificity was 83.3%),and Hosmer-Lemmeshaw test had a good fit(χ^(2)=11.915,P=0.155).Conclusion PPS score,lactate dehydrogenase(LDH),and D-dimer maybe are the influencing factors for predicting the occurrence of VTE in AECOPD in Kangbei plateau.The prediction model constructed by the combination of the three factors has good performance in predicting the risk of VTE in AECOPD,which can provide a reference for predicting the risk of VTE in AECOPD.
作者
付道芳
徐治波
陈红
邓正旭
文艳梅
董会琼
朗卡拉姆
蒋冬梅
FU Daofang;XU Zhibo;CHEN Hong;DENG ZHengxu;WEN Yanmei;DONG Huiqiong;LANGKA Lamu;JIANG Dongmei(Department of Respiratory Medicine,the No.2 People′s Hospital of Chengdu,Chengdu,Sichuan 610017,China;Department of Internal Medicine,Ganzi County People′s Hospital,Ganzi,Sichuan 626700,China)
出处
《临床肺科杂志》
2024年第2期178-183,共6页
Journal of Clinical Pulmonary Medicine
基金
成都市科技惠民项目(No.2015-HM01-00621-SF)。
关键词
静脉血栓栓塞症
慢性阻塞性肺疾病急性加重
高海拔
藏区
预测模型
venous thromboembolism
acute exacerbation of chronic obstructive pulmonary disease
high altitude
Tibetan area
prediction model
作者简介
通信作者:徐治波,E-mail:xuzhibo880@126.com。
