摘要
目的探讨依据肿瘤患者外周静脉置入中心静脉导管(PICC)相关性上肢静脉血栓风险的危险因素构建的列线图预测模型的临床价值。方法采用前瞻性队列研究,便利抽样法选择2016年1月至2017年3月在浙江省肿瘤医院行PICC置管肿瘤患者1032例,采用Cox回归模型分析PICC相关性上肢静脉血栓发生的危险因素,建立PICC置管后上肢静脉血栓发生风险的列线图预测模型,采用Bootstrap法进行内部检验,采用图形校准法对列线图进行验证。结果多因素Cox回归分析显示,血栓史(HR=27.82,95%CI 8.17~94.88,P<0.01)和高脂血症(HR=3.01,95%CI 1.31~6.93,P=0.009)是PICC相关性上肢静脉血栓的独立危险因素。以此建立的列线图模型C指数为0.71(95%CI 0.63~0.80),显示模型具有良好的区分度。1周、2周、1个月内预测PICC相关性上肢静脉血栓风险概率的校准曲线略偏离标准曲线,提示该模型有可能高估肿瘤患者PICC相关性上肢静脉血栓发生风险。结论列线图模型具有良好的预测价值且可操作性强,可以用于预测肿瘤患者PICC置管后PICC相关性上肢静脉血栓的发生概率,从而识别高危患者,为制定临床决策提供参考依据。
Objective To investigate the value of nomogram predictive model established by the risk factors of upper extremity venous thrombosis risk associated with peripherally venous inserted central catheter(PICC)in cancer patients.Methods A total of 1032 patients who underwent PICC insertion between January 2016 and March 2017 in Zhejiang Cancer Hospital were selected by using prospective cohort study and convenience sampling.Risk factors of upper extremity venous thrombosis risk associated with PICC in cancer patients were evaluated by using Cox regression model.The nomogram predictive model of upper extremity venous thrombosis risk associated with PICC insertion was constructed.Bootstrap method was used to complete the inside check,and figure calibration was used to verify the nomogram.Results A multivariate Cox regression analysis showed that trombosis history(HR=27.82,95%CI 8.17-94.88,P<0.01)and hyperlipidemia(HR=3.01,95%CI 1.31-6.93,P=0.009)were independent risk factors for upper extremity venous thrombosis associated with PICC.The nomogram model C-index was 0.71(95%CI 0.63-0.80)based on the above risk factors,which indicated that the nomogram had a good differentiation.The calibration curve for predicting the probability of upper extremity venous thrombosis risk associated with PICC within one week,two weeks and one month deviated slightly from the standard curve,suggesting that the model might overestimate the risk of upper extremity venous thrombosis associated with PICC in cancer patients.Conclusions The nomogram model has a good predictive value and strong operability,which can be used to predict the probability of upper extremity venous thrombosis associated with PICC in cancer patients after PICC insertion.It can provide a reference for identifying the high-risk cancer patients and formulating proper therapeutic strategies.
作者
杨方英
华荣誉
吴婉英
毕丹凤
吴怡
王锦毓
高利琴
梁冠冕
吴红娟
Yang Fangying;Hua Rongyu;Wu Wanying;Bi Danfeng;Wu Yi;Wang Jinyu;Gao Liqin;Liang Guanmian;Wu Hongjuan
出处
《肿瘤研究与临床》
CAS
2020年第7期456-461,共6页
Cancer Research and Clinic
基金
浙江省医药卫生平台计划(2016ZDA003)。
关键词
导管插入术
中心静脉
上肢静脉血栓形成
肿瘤
列线图
Catheterization
central venous
Upper extremity venous thrombosis
Neoplasms
Nomograms
