全膝置换术后症状性深静脉血栓危险因素

Risk factors for symptomatic deep vein thrombosis after total knee replacement

摘要:

［摘要］：目的 分析全膝关节置换（total knee arthroplasty,TKA）术后症状性深静脉血栓（deep vein thrombosisDVT）发生的危险因素，建立预测模型并验证。 方法 回顾性分析2018年-2023年于遵义市第一人民医院关节外科行TKA治疗的926例患者纳入研究。其中，血栓组有76名，无症状组有850名。我们将患者资料使用Logistic回归分析来研究TKA术后症状性DVT的风险因素，然后构建预测模型，在通过受试者工作特征曲线（receiver operating characteristic curve,ROC），拟合优度检验验证模型性能。结果 多因素Logistic回归分析显示，吸烟（OR=2.330 ,P=0.008）、下肢静脉瓣膜功能不全(OR= 2.230,P=0.027）、高血压（OR=1.240 ,P<0.001）、血小板/淋巴细胞比值（platelet/lymphocyte ratio,PLR）（OR=1.840 ,P<0.001）、C-反应蛋白（C-reactive protein,CRP）（OR=1.040 ,P=0.031）为TKA术后症状性DVT的危险因素（P<0.05）。该模型在预测TKA术后症状性DVT风险方面表现出良好的区分度，模型分类能力为82.29%，经卡方检验模型有效(x2=102.83, P<0.001)。结论 本研究表明吸烟、下肢静脉瓣膜功能不全、高血压、PLR及CRP这5项为TKA术后症状性DVT的危险因素, 构建的预测TKA术后症状性DVT风险的预测模型, 具有良好的区分度，可为临床个体化的防治术后症状性DVT提供参考。

Abstract:

［Abstract］:Objective To analyze the risk factors for the occurrence of symptomatic deep vein thrombosis (DVT) after total knee arthroplasty (TKA), and to establish a prediction model and validate it. Methods A retrospective analysis was performed for 926 patients who underwent TKA in the Department of Joint Surgery, Zunyi First People's Hospital from 2018 to 2023. Among them, 76 were in the thrombosis group and 850 were in the asymptomatic group. We used logistic regression analysis to investigate the risk factors of symptomatic DVT after TKA, and then constructed a prediction model to verify the performance of the model by receiver operating characteristic curve (ROC) and goodness-of-fit test. Results Multivariate Logistic regression analysis showed that smoking (OR=2.330, P=0.008), lower extremity venous valve insufficiency (OR=2.230, P=0.027), hypertension (OR=1.240, P<0.001), platelet/lymphocyte ratio (PLR) (OR=1.840, P<0.001) and C-reactive protein (CRP) (OR=1.040, P=0.031) were risk factors for symptomatic DVT after TKA (P<0.05). The model showed good discrimination in predicting the risk of symptomatic DVT after TKA, and the model classification ability was 82.29%, and the chi-square test was valid (x2=102.83, P). <0.001)。Conclusion This study showed that smoking, venous valve insufficiency of the lower extremities, hypertension, PLR and CRP were five risk factors for symptomatic DVT after TKA.The proposed prediction model for predicting the risk of symptomatic DVT after TKA has a good degree of discrimination, which can provide a reference for the prevention and treatment of postoperative symptomatic DVT in clinical individualization.