摘要
目的探讨内源性硫化氢(endogenous hydrogen sulfidem,H_(2)S)、血浆凝血酶-抗凝血酶复合物(thrombin/antithrombin complex,TAT)及可溶性血小板内皮细胞黏附分子-1(soluble platelet endothelial cell adhesion molecule 1,sPECAM-1)对老年髋部骨折围术期下肢深静脉血栓形成(deep vein thrombosis,DVT)的预测价值。方法选取2018年11月至2019年7月北京积水潭医院急诊科住院接受手术治疗的新发老年髋部骨折患者187例,随机抽取120例患者(建模集),采用多因素logistic回归方程分析建模集患者DVT的影响因素,并建立预测模型;将剩余67例患者纳入验证集,进行预测模型的内部验证。结果建模集120例患者中男39例(32.50%),女81例(67.50%);平均年龄(78.6±7.1)岁;BMI为(22.5±4.2)kg/m^(2)。多因素logisitic回归分析显示,BMI、发病至就诊的时间及TAT越高,H_(2)S及sPECAM-1越低的患者,越容易发生DVT(P<0.05)。建立的DVT风险预测模型为:logit(P)=0.130×BMI+0.010×发病至就诊的时间-0.098×H_(2)S+0.039×TAT-0.322×sPECAM-1-3.581。预测模型的ROC曲线的AUC为0.844(95%CI:0.774~0.915,P=0.000)。应用验证集数据对模型进行内部验证结果显示验证模型的ROC曲线的AUC为0.816(95%CI:0.713~0.919,P=0.000)。结论基于BMI、受伤至入院时间、TAT、H_(2)S和sPECAM-1等因素建立的模型对于预测老年髋部骨折患者围术期DVT的发生具有良好的筛查能力。
Objective To explore endogenous hydrogen sulfidem(H_(2)S),plasma thrombin/antithrombin complex(TAT)and soluble platelet endothelial cell adhesion molecule-1(sPECAM-1)in predicting deep vein thrombosis(DVT)of lower limbs in the perioperative period of hip fracture in the elderly.Methods A total of 187 newly diagnosed elderly patients with hip fracture who were admitted to the emergency department of Beijing Jishuitan Hospital and hospitalized for surgical treatment from November 2018 to July 2019 were selected,and a total of 120 patients were randomly selected into the modeling set,the influencing factors of DVT in the modeling set were analyzed by multivariate logistic regression equation,and a prediction model was established.The remaining 67 patients were included in the validation set for internal validation of the prediction model.Results Among the 120 patients in the modeling set,39 were males(32.50%)and 81 were females(67.50%).The average age was(78.6±7.1)years,and the BMI was(22.5±4.2)kg/m^(2).Multivariate logisitic regression analysis showed that patients with higher BMI,more time from onset to treatment,higher TAT,lower H_(2)S and lower sPECAM-1 were more likely to develop DVT(P<0.05).The established risk prediction model for DVT was as follows:logit(P)=0.130×BMI+0.010×time from onset to treatment-0.098×H_(2)S+0.039×TAT-0.322×sPECAM-1-3.581.The AUC of the ROC curve of the prediction model was 0.844(95%CI:0.774-0.915,P=0.000).The results of internal validation of the model by using the verification set data showed that the AUC of the ROC curve of the verification model was 0.816(95%CI:0.713-0.919,P=0.000).Conclusions The model based on BMI,time from injury to hospital admission,TAT,H_(2)S and sPECAM-1 has a good screening ability to predict the occurrence of DVT in elderly patients with hip fracture during perioperative period.
出处
《北京医学》
CAS
2023年第9期749-752,757,共5页
Beijing Medical Journal
基金
北京积水潭医院“学科骨干”计划专项(XKGG202204)
北京市医院管理中心“青苗”计划专项(QML20210405)
关键词
内源性硫化氢
髋部骨折
深静脉血栓
预测模型
老年
endogenous hydrogen sulfide(H_(2)S)
hip fracture
deep vein thrombosis(DVT)
prediction model
eldely
