【摘要】 目的 构建并验证下肢静脉血栓介入综合治疗后出现血栓后综合征（PTS）的预测模型。方法 选择2017年3月至2020年3月常德市第一人民医院收治的下肢静脉血栓患者119例，所有患者均接受经导管接触溶栓、临时下腔静脉滤器植入、支架植入术或球囊扩张狭窄/闭塞段、机械性血栓清除治疗。随访3年，根据下肢静脉血栓介入综合治疗后是否发生PTS分为发生组与非发生组。对比两组临床资料，采用二元Logistic回归法分析下肢静脉血栓介入综合治疗后发生PTS的影响因素。构建下肢静脉血栓介入综合治疗后发生PTS的列线图预测模型，采用Hosmer-Lemeshow检验评估拟合度，ROC曲线评估预测模型区分度。结果 随访3年，119例患者失访3例，随访率为97.48%，其中37例发生PTS，发生率31.90%。发生组体质量指数（BMI）≥24 kg/m~2（超重）、病程≥2周、有静脉曲张、血栓清除分级为Ⅰ～Ⅱ级、髂股静脉血栓、无弹力支持例数占比高于非发生组（χ~2=7.484、15.309、31.795、17.098、11.359、4.156,P<0.05）。Logistic回归分析结果显示，BMI≥24 kg/m~2、病程≥2周、有静脉曲张、血栓清除分级为Ⅰ～Ⅱ级、无弹力支持为下肢静脉血栓介入综合治疗后发生PTS的影响因素[OR(95%CI)=3.504(1.540～7.972)、5.244(2.305～11.928)、3.532(1.552～8.036)、4.328(1.902～9.844)、4.179(1.837～9.506),P<0.05]。以上述影响因素作为预测变量，建立列线图预测模型，各因素总分范围76～426分，对应风险率范围0.05～0.80。列线图模型的C-index指数为0.867(95%CI=0.762～0.883)，预测下肢静脉血栓介入综合治疗后发生PTS的风险的校正曲线趋近于理想曲线（χ~2=0.309,P > 0.05）。ROC曲线结果显示：列线图模型预测下肢静脉血栓介入综合治疗后发生PTS的敏感度为89.19%，特异度为89.87%,AUC为0.905(95%CI=0.861～0.963)。结论 超重、病程较长、有静脉曲张、血栓清除分级低、无弹力支持与下肢静脉血栓介入综合治疗后发生PTS的风险有关，构建列线图模型有助于早期甄别下肢静脉血栓介入综合治疗后发生PTS的风险。更多还原

【Abstract】 Objective To construct and validate the prediction model for post-thrombotic syndrome(PTS) after comprehensive interventional treatment of lower extremity venous thrombosis. Methods A total of 119 patients with lower extremity venous thrombosis treated at the First People’s Hospital of Changde from March 2017 to March 2020 were selected. All patients underwent catheter-directed thrombolysis, temporary inferior vena cava filter implantation, stent implantation or balloon dilation of stenosis/occlusion segments, and percutaneous mechanical thrombectomy. The patients were followed up for 3 years, and were divided into the occurrence group and the non-occurrence group according to whether PTS occurred after comprehensive interventional treatment of lower extremity venous thrombosis. The clinical data of the two groups were compared, binary Logistic regression method was used to analyze the influencing factors of PTS after comprehensive interventional treatment of lower limb venous thrombosis. The nomogram prediction model of PTS after comprehensive interventional treatment of lower extremity venous thrombosis was constructed. Hosmer-Lemeshow test was used to evaluate the fitness. ROC curves were used to evaluate the discriminative ability of the predictive model. Results After 3 years of follow-up, 3 of 119 patients were lost to follow-up, resulting in a follow-up rate of 97.48%. Among them, 37 patients developed PTS, with an incidence rate of 31.90%. The proportions of body mass index(BMI) ≥ 24k g/m~2(overweight), disease course ≥ 2 weeks, presence of varicose veins, thrombus removal gradeⅠ-Ⅱ, iliofemoral vein thrombosis, and lack of elastic support were higher in the occurrence group than those in the non-occurrence group(χ~2/t=7.484, 15.309, 31.795, 17.098,11.359, 4.156; P < 0.05). Binary Logistic regression analysis revealed that BMI ≥ 24 kg/m~2, disease course ≥ 2 weeks, presence of varicose veins, thrombus removal gradeⅠ-Ⅱ, and lack of elastic support were the influencing factors for the development of PTS after comprehensive interventional treatment of lower extremity venous thrombosis [OR(95%CI)=3.504(1.540-7.972), 5.244(2.305-11.928), 3.532(1.552-8.036), 4.328(1.902-9.844), 4.179(1.837-9.506); P < 0.05]. Taking the above influencing factors as predictive variables, a nomogram prediction model was established. The total score of each factor ranged from 76 to 426, and the corresponding risk rate ranged from 0.05 to 0.80. The C-index of the nomogram model was 0.867(95%CI=0.762-0.883), and the calibration curve for predicting the risk of PTS after comprehensive interventional treatment of lower limb venous thrombosis was close to the ideal curve(χ~2=0.309, P > 0.05). ROC curve results showed that the sensitivity, specificity and AUC of the nomogram model in predicting PTS after comprehensive interventional treatment of lower limb venous thrombosis were 89.19%, 89.87% and 0.905(95%CI=0.861-0.963). Conclusion Overweight, long course of disease, varicose veins, low thrombus removal grade, and lack of elastic support are associated with the risk of PTS after comprehensive interventional treatment of lower limb venous thrombosis. The construction of a nomogram model is helpful for early identification of the risk of PTS after comprehensive interventional treatment for lower extremity venous thrombosis.更多还原