摘要
目的:分析肿瘤化疗患者发生输液港相关血栓的影响因素,并构建风险预测模型进行验证。方法:回顾性分析2019年7月至2022年12月于滨州医学院附属医院接受化疗并植入输液港的320例恶性肿瘤患者的临床资料,根据是否发生输液港相关血栓将其分为血栓组和非血栓组。收集患者基线资料,采用Logistic回归分析肿瘤化疗患者发生输液港相关血栓的影响因素,构建风险预测模型,并基于模型变量绘制列线图进行验证。结果:320例肿瘤化疗患者中,58例发生输液港相关血栓,发生率为18.13%(58/320);两组性别、体质量指数、吸烟史、饮酒史、输血史、手术史、合并高血压、高脂血症史、临床分期、化疗次数、置管次数、活动情况、C反应蛋白水平、使用植物类化疗药物、使用抗肿瘤抗生素、使用抗代谢化疗药物、使用烷化剂、置管期间服用激素、置管期间感染比较,差异均无统计学意义(P>0.05);两组年龄、血栓形成史、导管尖端位置、D-二聚体(D-D)水平、纤维蛋白原(FIB)水平、使用铂类化疗药物比较,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,年龄≥60岁、有血栓形成史、导管尖端位置异常、D-D水平≥1.5 mg/L、FIB水平≥4.0 g/L、使用铂类化疗药物均为肿瘤化疗患者发生输液港相关血栓的危险因素(OR>1,P<0.05);基于上述危险因素构建风险预测列线图模型,校准曲线与实际曲线吻合良好,拟合度曲线吻合率为81.15%;受试者工作特征曲线下面积为0.869,95%CI为0.748~0.912,灵敏度为83.06%,特异度为82.23%;决策曲线显示临床使用净效益较高。结论:年龄≥60岁、有血栓形成史、导管尖端位置异常、D-D水平≥1.5 mg/L、FIB水平≥4.0 g/L、使用铂类化疗药物均为肿瘤化疗患者发生输液港相关血栓的危险因素,基于上述危险因素构建的风险预测模型可用于临床风险评估。
Objective:To analyze influencing factors of infusion port-related thrombosis in patients with tumor chemotherapy,and to construct a risk prediction model for verification.Methods:The clinical data of 320 patients with malignant tumors who received chemotherapy and were implanted with infusion port in the Affiliated Hospital of Binzhou Medical University from July 2019 to December 2022 were retrospectively analyzed.According to whether there was infusion port-related thrombosis,they were divided into thrombosis group and non-thrombosis group.The baseline data of these patients were collected.Logistic regression was used to analyze the influencing factors of infusion port-related thrombosis in the patients with tumor chemotherapy,a risk prediction model was constructed,and a nomogram was drawn based on the model variables for verification.Results:Among the 320 patients with tumor chemotherapy,58 patients had infusion port-related thrombosis with an incidence of 18.13%(58/320).There were no significant differences in gender,body mass index,smoking history,drinking history,blood transfusion history,surgical history,history of hypertension and hyperlipidemia,clinical stage,number of chemotherapy,number of catheterization,activities,C-reactive protein level,use of plant-based chemotherapeutic drugs,use of anti-tumor antibiotics,use of anti-metabolic chemotherapeutic drugs,use of alkylating agents,use of hormones during catheterization,and infection during catheterization between the two groups(P>0.05).There were statistically significant differences in age,history of thrombosis,catheter tip position,D-dimer(D-D)level,fibrinogen(FIB)level,and use of platinum chemotherapeutic drugs between the two groups(P<0.05).Logistic regression analysis showed that age≥60 years old,history of thrombosis,abnormal catheter tip position,D-D level≥1.5 mg/L,FIB level≥4.0 g/L,and use of platinum chemotherapeutic drugs were all risk factors for infusion port-related thrombosis in the patients with tumor chemotherapy(OR>1,P<0.05).Based on the above risk factors,a risk prediction nomogram model was constructed,and it showed that the calibration curve was in good agreement with the actual curve,and the coincidence rate of the fitting curve was 81.15%.The area under the receiver operating characteristic curve was 0.869,95%CI was 0.748-0.912,the sensitivity was 83.06%,and the specificity was 82.23%.Further,the decision curve showed that the net benefit of clinical use was higher.Conclusions:Age≥60 years old,history of thrombosis,abnormal catheter tip position,D-D level≥1.5 mg/L,FIB level≥4.0 g/L,and use of platinum chemotherapeutic drugs are the factors for infusion port-related thrombosis in the patients with tumor chemotherapy.The risk prediction model based on the above risk factors can be used for clinical risk assessment.
作者
黄家香
李明月
齐岩强
栾顺莲
HUANG Jiaxiang;LI Mingyue;QI Yanqiang;LUAN Shunlian(Pelvic ward of Department of Oncology of Affiliated Hospital of Binzhou Medical College,Binzhou 256600 Shandong,China;Integrated Chinese and Western Medicine Ward of Shengli Oilfield Central Hospital,Dongying 257099 Shandong,China)
出处
《中国民康医学》
2025年第24期13-18,共6页
Medical Journal of Chinese People’s Health
基金
滨州医学院科研计划与科研启动基金项目(BY2022KJ57)。
关键词
肿瘤
化疗
输液港相关血栓
影响因素
模型
验证
Tumor
Chemotherapy
Infusion port-related thrombosis
Influencing factor
Model
Verification
