摘要
目的 分析血栓弹力图(TEG)和凝血指标在肿瘤相关静脉血栓栓塞症(TAVTE)中的预测价值.方法 采用病例对照研究,收集2022年1月—2023年5月安宁市第一人民医院167例恶性实体肿瘤住院患者,按是否确诊TAVTE分为观察组(31例)和对照组(136例).比较2组患者一般临床资料和血细胞分析、凝血指标、TEG、血糖、血脂等实验室指标的差异.采用Logistic回归分析评估TAVTE的影响因素,并建立列线图预测模型.采用受试者工作特征(ROC)曲线和临床决策曲线(DCA)评价列线图预测模型的效能.结果 观察组和对照组肿瘤分期、手术史、Caprini评分、红细胞、血红蛋白、血细胞比容、白蛋白、国际标准化比值、凝血酶原时间、抗凝血酶Ⅲ、D-二聚体差异均有统计学意义(P＜0.05),其他指标差异无统计学意义(P＞0.05).Logistic回归分析结果显示,肿瘤分期、合并糖尿病、D-二聚体、TEG参数血栓最大振幅(MA)是影响TAVTE的独立危险因素(P＜0.05).建立的列线图预测模型判断TAVTE的敏感性和特异性分别为87.1％和66.2％,曲线下面积为0.819,具有较好的临床应用价值.结论 TEG参数MA和凝血指标D-二聚体对TAVTE有较大的预测价值.建立列线图预测模型能较好地预测TAVTE.
Abstract
Objective To analyze the roles of thromboelastography(TEG)and coagulation index in predicting tumor-associated venous thromboembolism(TAVTE).Methods A case control study was used to enroll 167 patients with malignant solid tumor admitted to the First People's Hospital of Anning from January 2022 to May 2023.They were classified into observation group(31 cases)and control group(136 cases)according to whether TAVTE was confirmed.The differences of general clinical data,blood cell analysis,coagulation test,TEG,blood glucose,blood lipid and other laboratory indexes were compared between the 2 groups.Logistic regression analysis was used to evaluate the influencing factors of TAVTE,and a nomogram prediction model was established.Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate the efficiency of the nomogram prediction model.Results There was statistical significance in tumor stage,surgical history,Caprini score,red blood cell,hemoglobin,haematocrit,albumin,international standardized ratio,prothrombin time,antithrombin Ⅲ and D-dimer between observation group and control group(P＜0.05),while there was no statistical significance in other general clinical data and laboratory indexes(P＞0.05).Tumor stage,diabetes mellitus,D-dimer and maximum amplitude(MA)were independent risk factors for TAVTE in tumor patients(P＜0.05).The sensitivity and specificity of the established nomogram prediction model were 87.1％and 66.2％,respectively,and the area under curve was 0.819.Conclusions TEG parameter MA and coagulation index D-dimer have predictive value for TAVTE.The nomogram prediction model can predict TAVTE well.
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