摘要
目的:研究原发性肝癌术后发生静脉血栓栓塞症(venous thromboembolism,VTE)的危险因素,并验证和改良Caprini模型对肝癌术后患者VTE发生的预测能力。方法:对我院收治的452例肝癌患者进行回顾性分析,根据术后1月内是否发生VTE而分为VTE组和非VTE组。采用多因素Logistic回归以用来筛选VTE发生的独立危险因素。采用受试者操作特征曲线(receiver operating characteristic,ROC)和曲线下面积(area under ROC curve,AUC)来描述和比较传统Caprini模型和改良Caprini模型对VTE发生预测的准确性。结果:共有41例原发性肝癌患者术后出现VTE,整体发生率为9.07%。单因素分析示BMI、糖尿病患病率、门静脉癌栓发生率、手术时间、二次手术率、以及Caprini评分可能与VTE的发生有关。多因素分析示BMI(OR=1.14,P=0.01)、手术时间(OR=10.91,P=0.001)、有门静脉癌栓(OR=4.98,P=0.001)、二次手术(OR=7.85,P=0.01)和Caprini评分(OR=2.63,P=0.001)是VTE发生的独立危险因素。改良后的Caprini模型和一般Caprini模型在预测VTE时的AUC分别为0.912和0.811;当取最大约登指数时,二者敏感度分别为85.37%和63.41%,特异度分别为85.64%和87.59%。结论:BMI、手术时间、门静脉癌栓、二次手术是原发性肝癌患者术后VTE发生的独立影响因素,联合上述四种指标可以显著提高Caprini模型对VTE的预测能力。
Objective:To study the risk factors of venous thromboembolism(VTE)after primary liver cancer resection,and to verify and improve the predictive ability of Caprini model for the prediction of VTE after hepatectomy.Methods:A total of 452 patients with liver cancer admitted to our hospital was respectively divided into VTE group and non-VTE group according to whether VTE occurred within 1 month after surgery.Multivariate logistic regression was used to screen independent risk factors for VTE.Receiver operating characteristic(ROC)and area under ROC curve(AUC)were used to describe and compare the accuracy of the prediction of the VTE between the traditional Caprini model and the modified Caprini model.Results:A total of 41 patients with primary liver cancer developed VTE after operation,with an overall incidence of 9.07%.Univariate analysis showed that BMI,prevalence of diabetes,portal vein tumor thrombosis,operation time,secondary operation rate,and Caprini score may be related to the occurrence of VTE.Multivariate analysis showed BMI(OR=1.14,P=0.01),operation time(OR=10.91,P=0.001),portal vein tumor thrombus(OR=4.98,P=0.001),secondary surgery(OR=7.85,P=0.01)and Caprini score(OR=2.63,P=0.001)were independent risk factors for VTE.The AUC of the modified Caprini model and the general Caprini model when predicting VTE were 0.912 and 0.811,respectively.When the maximum Youden index was taken,the sensitivity of the two models were 85.37%and 63.41%,respectively,and the specificity was 85.64%and 87.59%,respectively.Conclusion:BMI,operation time,portal vein tumor thrombus,and secondary surgery are independent factors of postoperative VTE in patients with primary liver cancer.Combining the above four indicators can significantly improve the predictive ability of general Caprini model for VTE.
作者
周建
王庆元
秦长岭
ZHOU Jian;WANG Qingyuan;QIN Changling(Department of General Surgical Biliary Tract,Nanyang Central Hospital,Henan Nanyang 473000,China;Department of General Surgical Liver Ward,Nanyang Central Hospital,Henan Nanyang 473000,China)
出处
《现代肿瘤医学》
CAS
北大核心
2022年第12期2214-2218,共5页
Journal of Modern Oncology
