摘要
目的:筛选老年髋部骨折后静脉血栓栓塞症(venous thromboembolism,VTE)风险的预测因素,建立老年髋部骨折后VTE风险的联合预测模型并分析其预测效能。方法:选取2017年3月至2019年4月中南大学湘雅医院创伤骨科收治的52名60岁以上的髋部骨折合并VTE的患者作为血栓组,并选取同期52名60岁以上的髋部骨折未合并VTE的患者作为对照组。比较两组临床资料和检验、检查结果的差异,通过logistic回归模型分析老年髋部骨折后VTE风险的影响因素,据此构建预测模型,应用受试者工作特征(receiver operating characteristic,ROC)曲线分析其预测效能,Hosmer-Lemeshow拟合优度检验评价其拟合程度。结果:单因素分析显示血栓组受伤-入院间隔时间、Caprini评分、白细胞(white blood cell,WBC)计数、血小板(platelet,PLT)计数、中性粒细胞计数(neutrophil count,NC)、中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet-tolymphocyte ratio,PLR)、单核细胞与淋巴细胞比值(monocyte-to-lymphocyte ratio,MLR)、系统免疫炎症指数(systemic immune-inflammation index,SII)、纤维蛋白原(fibrinogen,FIB)均高于对照组(均P<0.05)。Logistic回归分析显示受伤-入院间隔时间、Caprini评分、SII为老年髋部骨折后VTE的独立预测因素。基于这3个指标构建的预测模型曲线下面积(area under curve,AUC)为0.949(95%CI:0.901~0.996),灵敏度、特异度分别为82.70%和96.20%,均明显优于各单一指标,且该模型的拟合程度好(Hosmer-Lemeshowχ^(2)=14.078,P>0.05)。结论:SII、Caprini评分、受伤-入院间隔时间是预测老年髋部骨折后VTE的独立影响因素,基于这3个指标建立的预测模型对VTE风险预测具有良好效能,可为临床上指导老年髋部骨折后VTE的预防、管理和治疗提供重要参考。
Objective:To screen the risk factors for predicting venous thromboembolism(VTE)risk after hip fracture in the elderly,to establish a prediction model based on these factors,and to analyze its prediction efficacy.Methods:A total of 52 hip fracture patients over 60 years old with VTE admitted to the Department of Orthopaedic Trauma,Xiangya Hospital,Central South University from March 2017 to April 2019 were selected as a thrombus group,and another 52 hip fracture patients over 60 years old without VTE were selected as a control group.The differences of hospitalization data and examination results between the 2 groups were compared.Logistic regression model was used to explore the influence of risk factors on VTE risk after hip fracture in the elderly and construct the prediction model based on these factors.The receiver operating characteristic curve was used to analyze the predictive effectiveness of model,Hosmer-lemeshow goodness of fit test was used to evaluate the fitting degree of prediction model.Results:Univariate analysis showed that injury-admission interval,Caprini score,WBC count,platelet count,neutrophil count,neutrophil-to-lymphocyte ratio,platelet-tolymphocyte ratio,monocyte-to-lymphocyte ratio,systemic immune-inflammatory index(SII),and fibrinogen in the thrombus group were higher than those in the control group(all P<0.05).Logistic regression analysis showed that injury-admission interval,Caprini score,and SII were independent predictors of VTE risk after hip fracture in the elderly.The AUC was 0.949(95%CI 0.901 to 0.996)when the sensitivity and specificity were 82.70%and 96.20%,respectively,which were significantly higher than each single index,and the prediction model had perfect fitting degree(Hosmer-lemeshowχ^(2)=14.078,P>0.05).Conclusion:SII,Caprini score,and injury-admission interval are independent predictors of VTE after hip fracture in the elderly.The prediction model based on these 3 factors has a good efficacy on the prediction of VTE risk,and could provide important reference for the prevention,management,and treatment of VTE after hip fracture in the elderly.
作者
彭江南
王昊晨
张亮
林涨源
PENG Jiangnan;WANG Haochen;ZHANG Liang;LIN Zhangyuan(Department of Orthopaedic Trauma,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2021年第2期142-148,共7页
Journal of Central South University ：Medical Science
基金
湖南省自然科学基金(2018JJ2650)。
关键词
系统免疫炎症指数
静脉血栓栓塞症
髋部骨折
预测模型
systemic immune-inflammatory index
venous thromboembolism
hip fracture
prediction model
