老年肺癌胸腔镜手术后下肢深静脉血栓的危险因素分析及预测模型的建立和验证

摘要/Abstract

摘要：

目的分析老年肺癌胸腔镜手术后下肢深静脉血栓的危险因素,建立列线图预测模型并进行内部验证。方法选择2018年2月至2022年2月在南充市中心医院行胸腔镜根治术治疗的183例老年肺癌患者作为研究对象。根据术后1个月内有无下肢深静脉血栓将患者分为下肢深静脉血栓组（n=61）和非下肢深静脉血栓组（n=122）。对老年肺癌胸腔镜手术后下肢深静脉血栓形成进行单因素及多因素分析,根据多因素分析结果构建列线图预测模型,并对模型进行验证。结果下肢深静脉血栓组与非下肢深静脉血栓组患者吸烟史（χ²=13.40,P<0.001）、术前化疗（χ²=8.79,P=0.003）、手术方式（χ²=7.97,P=0.005）、手术时间（t=7.23,P<0.001）、术后卧床时间（t=10.40,P<0.001）、合并糖尿病（χ²=6.37,P=0.012）、合并高脂血症（χ²=9.58,P=0.002）、术前D-二聚体（t=13.08,P<0.001）、术前纤维蛋白原（t=5.84,P<0.001）、术前血小板计数（t=7.01,P<0.001）差异均具有统计学意义。logistic回归分析结果显示,术前化疗（OR=2.45,95%CI为1.05~5.71,P=0.038）、手术方式（OR=2.55,95%CI为1.14~5.73,P=0.023）、术后卧床时间（OR=1.50,95%CI为1.24~1.81,P<0.001）、合并糖尿病（OR=3.60,95%CI为1.05~12.33,P=0.042）、术前D-二聚体（OR=1.01,95%CI为1.01~1.01,P<0.001）均为老年肺癌胸腔镜手术后下肢深静脉血栓形成的独立影响因素。列线图预测下肢深静脉血栓相关因素的C-index为0.86（95%CI为0.81~0.93）,校准曲线显示本模型预测下肢深静脉血栓形成的相关性良好。结论术前化疗、手术方式、术后卧床时间、合并糖尿病、术后D-二聚体水平为老年肺癌胸腔镜术后下肢深静脉血栓形成的影响因素,本研究建立的列线图预测模型对老年肺癌胸腔镜术后下肢深静脉血栓形成预测具有较高的准确性与区分度。

关键词:肺肿瘤,老年人,胸腔镜检查,静脉血栓形成,危险因素

Abstract:

ObjectiveTo analyze the risk factors of lower extremities deep vein thrombosis after thoracoscopic surgery in elderly patients with lung cancer, establish a nomogram prediction model and conduct internal verification.MethodsA total of 183 elderly patients with lung cancer who underwent thoracoscopic radical resection in Nanchong Central Hospital from February 2018 to February 2022 were selected as the study subjects. According to the presence or absence of deep venous thrombosis of the lower extremities within one month after operation, the patients were divided into lower extremities deep venous thrombosis group （n=61） and non-deep lower extremities venous thrombosis group （n=122）. Univariate and multivariate analyses of deep venous thrombosis of lower extremities after thoracoscopic surgery for lung cancer in the elderly were performed, and a nomogram prediction model was constructed according to the multivariate analysis results, and the model was verified.ResultsThere were statistically significant differences in smoking history （χ²=13.40,P<0.001）, preoperative chemotherapy （χ²=8.79,P=0.003）, surgical method （χ²=7.97,P=0.005）, operation time （t=7.23,P<0.001）, postoperative bed rest time （t=10.40,P<0.001）, combined with diabetes （χ²=6.37,P=0.012）, combined with hyperlipidemia （χ²=9.58,P=0.002）, preoperative D-dimer （t=13.08,P<0.001）, preoperative fibrinogen （t=5.84,P<0.001） and preoperative platelet count （t=7.01,P<0.001） between the lower extremity deep venous thrombosis group and the non-lower extremity deep venous thrombosis group. The results of multivariate logistic regression analysis showed that preoperative chemotherapy （OR=2.45, 95%CI： 1.05-5.71,P=0.038）, surgical method （OR=2.55, 95%CI： 1.14-5.73,P=0.023）, postoperative bed rest time （OR=1.50, 95%CI： 1.24-1.81,P<0.001）, combined with diabetes （OR=3.60, 95%CI： 1.05-12.33,P=0.042）, and preoperative D-dimer （OR=1.01, 95%CI： 1.01-1.01,P<0.001） were all independent risk factors for lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery. The C-index of nomogram for predicting lower extremity deep vein thrombosis-related factors was 0.86 （95%CI： 0.81-0.93）. The calibration curve showed that the model had a good correlation in predicting lower extremities deep venous thrombosis.ConclusionPreoperative chemotherapy, surgical method, postoperative bed rest time, combined with diabetes, and postoperative D-dimer level are influence factors for lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery. The nomogram prediction model established in this study has high accuracy and discrimination for the prediction of lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery.

Key words:Lung neoplasms,Aged,Thoracoscopy,Venous thrombosis,Risk factors

杨莎, 杨晓华, 王苏华, 薛晓燕, 徐俊. 老年肺癌胸腔镜手术后下肢深静脉血栓的危险因素分析及预测模型的建立和验证[J]. 国际肿瘤学杂志, 2022, 49(9): 532-536.

Yang Sha, Yang Xiaohua, Wang Suhua, Xue Xiaoyan, Xu Jun. Analysis of risk factors for deep vein thrombosis of lower extremity after thoracoscopic surgery for elderly lung cancer and establishment and validation of prediction model[J]. Journal of International Oncology, 2022, 49(9): 532-536.

图/表4

表1

影响183例老年肺癌患者胸腔镜手术后下肢深静脉血栓形成的单因素分析[例（%）/ $\bar{x}±s$]"

因素	下肢深静脉血栓组（n=61）	非下肢深静脉血栓组（n=122）	χ²/t值	P值
性别
男	35（57.38）	74（60.66）	0.18	0.670
女	26（42.62）	48（39.34）	0.18	0.670
年龄（岁）	67.81±9.03	69.54±10.16	-1.13	0.262
BMI（kg/m²）	22.03±4.71	21.85±5.03	0.23	0.816
吸烟史
无	18（29.51）	71（58.20）	13.40	<0.001
有	43（70.49）	51（41.80）	13.40	<0.001
病理类型
腺癌	19（31.15）	38（31.15）
鳞状细胞癌	40（65.57）	79（64.75）	0.08	0.963
其他	2（3.28）	5（4.10）
TNM分期
Ⅰ	24（39.34）	52（42.62）
Ⅱ	25（40.98）	45（36.89）	0.30	0.862
Ⅲ	12（19.67）	25（20.49）
术前化疗
无	34（55.74）	94（77.05）	8.79	0.003
有	27（44.26）	28（22.95）	8.79	0.003
手术方式
肺段切除	22（36.07）	71（58.20）	7.97	0.005
肺叶切除	39（63.93）	51（41.80）	7.97	0.005
术中出血量（ml）	250.11±68.01	237.13±71.35	1.18	0.240
手术时间（h）	3.35±0.97	2.41±0.75	7.23	<0.001
术后卧床时间（d）	4.81±1.35	3.11±0.83	10.40	<0.001
肺部感染
无	52（85.25）	107（87.70）	0.22	0.642
有	9（14.75）	15（12.30）	0.22	0.642
合并糖尿病
无	48（78.69）	112（91.80）	6.37	0.012
有	13（21.31）	10（8.20）	6.37	0.012
合并高脂血症
无	45（73.77）	111（90.98）	9.58	0.002
有	16（26.23）	11（9.02）	9.58	0.002
术前D-二聚体（mg/L）	631.08±95.11	451.03±83.96	13.08	<0.001
术前纤维蛋白原（g/L）	4.51±1.17	3.58±0.93	5.84	<0.001
术前血小板计数（×10⁹/L）	373.27±102.11	284.02±68.51	7.01	<0.001
术前白细胞计数（×10⁹/L）	11.03±2.51	10.81±2.36	0.58	0.561

表1

表2

影响183例老年肺癌患者胸腔镜手术后下肢深静脉血栓形成的多因素分析"

变量	Β值	SE值	Wald值	OR值	95%CI	P值
常量	-6.98	1.04	44.86	0.01		<0.001
吸烟史	0.32	0.19	2.84	1.37	0.95~1.99	0.092
术前化疗	0.90	0.43	4.30	2.45	1.05~5.71	0.038
手术方式	0.94	0.41	5.16	2.55	1.14~5.73	0.023
手术时间	0.23	0.14	2.49	1.26	0.95 ~1.66	0.115
术后卧床时间	0.41	0.10	17.32	1.50	1.24~1.81	<0.001
合并糖尿病	1.28	0.63	4.15	3.60	1.05~12.33	0.042
合并高脂血症	0.46	0.25	3.44	1.59	0.97 ~2.59	0.064
术前D-二聚体	0.01	0.01	26.40	1.01	1.01~1.02	<0.001
术前纤维蛋白原	0.30	0.17	3.02	1.35	0.96 ~1.88	0.082
术前血小板计数	0.23	0.15	2.15	1.25	0.93 ~1.70	0.142

表2

图1

图2

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