發(fā)布時(shí)間：2018-07-15 09:11

【摘要】：目的：探討肝硬化門靜脈高壓癥脾切除術(shù)后門靜脈血栓(portal venous system thrombosis PVT)形成危險(xiǎn)因素并建立Logistic回歸預(yù)測(cè)模型,評(píng)價(jià)該模型對(duì)于判斷脾切除術(shù)后形成PVT的預(yù)測(cè)價(jià)值。方法：收集新疆醫(yī)科大學(xué)第一附屬醫(yī)院2009-01-01/2013-12-31期間因肝硬化門靜脈高壓導(dǎo)致脾功能亢進(jìn)和/或食道胃底靜脈曲張行脾切除術(shù)治療患者的圍手術(shù)期臨床資料,以術(shù)后2周是否發(fā)生PVT為標(biāo)準(zhǔn)分組,對(duì)圍術(shù)期相關(guān)臨床危險(xiǎn)因素進(jìn)行單因素分析和多因素Logistic回歸分析,根據(jù)多因素分析結(jié)果建立Logistic回歸預(yù)測(cè)模型,繪制術(shù)后2周PVT形成風(fēng)險(xiǎn)情況的ROC曲線,評(píng)價(jià)該模型對(duì)于判斷術(shù)后形成PVT風(fēng)險(xiǎn)的預(yù)測(cè)價(jià)值。結(jié)果：多因素結(jié)果分析顯示術(shù)后5-7天血小板計(jì)數(shù)(PLT)、血小板體積(mean platelet volume MPV)、D-二聚體(D-Dimer)為術(shù)后2周患者發(fā)生PVT的獨(dú)立危險(xiǎn)因素,術(shù)后使用抗凝藥物(usage of anticoagulation therapy UAT)、術(shù)后使用降低門靜脈壓力藥物(usage of reducing portal pressure therapy URPT)為術(shù)后2周患者發(fā)生PVT的獨(dú)立保護(hù)因素,根據(jù)上述指標(biāo)建立Logistic回歸預(yù)測(cè)模型：Logit P=-9.165+0.664×PLT (×1011/L)+0.413× MPV (fL)+0.662×D-Dimer (mg/L)-1.674×UAT(是=1,否=0)-1.518×URPT(是=1,否=0),界值為-1.14,ROC曲線下的面積為0.865,準(zhǔn)確度為84.03%,而方程中的各獨(dú)立危險(xiǎn)因素PLT、MPV、D-Dimer所對(duì)應(yīng)的界值點(diǎn)分別為4.42×1011/L、13.30 fL、2.55mg/L。結(jié)論：本項(xiàng)研究得出脾切除術(shù)后5-7天當(dāng)PLT≥4.42×1011/L、MPV≥ 13.30fL、D-Dimer≥2.55mg/L將明顯增加PVT發(fā)生風(fēng)險(xiǎn),術(shù)后UAT和URPT可以有效減少PVT的發(fā)生,對(duì)判斷肝硬化脾切除術(shù)后2周形成PVT的風(fēng)險(xiǎn)建立了準(zhǔn)確性達(dá)到84.03%的預(yù)測(cè)模型,該模型靈敏度、特異度、準(zhǔn)確度高,我們的模型對(duì)于圍術(shù)期選擇合理的干預(yù)方法預(yù)防PVT形成提供了明確的數(shù)學(xué)模型及臨界值,進(jìn)一步驗(yàn)證其準(zhǔn)確性具有重要的臨床意義和價(jià)值。
[Abstract]:Objective: to investigate the risk factors of portal hypertension in patients with cirrhosis after splenectomy and to establish a logistic regression model to evaluate the predictive value of the model in predicting the formation of (portal venous system thrombosis after splenectomy. Methods: the perioperative clinical data of patients with hypersplenism and / or esophageal varices caused by cirrhosis and portal hypertension during 2009-01-01 / 2013-12-31 in the first affiliated Hospital of Xinjiang Medical University were collected. According to whether PVT occurred at 2 weeks after operation, univariate analysis and multivariate logistic regression analysis were used to analyze the clinical risk factors in perioperative period, and a logistic regression prediction model was established according to the results of multivariate analysis. The ROC curve of PVT formation risk was drawn 2 weeks after operation, and the predictive value of the model for predicting the risk of PVT formation was evaluated. Results: multivariate analysis showed that platelet count (PLT), platelet volume (mean platelet volume) and D-Dimer (D-Dimer) were independent risk factors of PVT in patients 2 weeks after operation. Postoperative anticoagulant (usage of anticoagulation therapy) and postoperative portal vein pressure reduction drug (usage of reducing portal pressure therapy UAT) were the independent protective factors for the occurrence of PVT 2 weeks after operation. According to the above indexes, a Logistic regression prediction model was established, logit Pfi-9.165 脳 PLT (脳 1011 / L) 0.413 脳 MPV (fL) 0.662 脳 D-Dimer (mg / L) -1.674 脳 UAT (is 1, 0) -1.518 脳 URPT (is 1, 0), the boundary value is -1.14 ~ (-1) ROC curve, the area under the curve is 0.865, the accuracy is 84.03, and the bound point of the independent risk factor PLTT MPV D-Dimer in the equation is 4.42 脳 1011L 13.30 fl ~ (-1) mg 路L ~ (-1) L = 2.55 mg 路L ~ (-1) 路L ~ (-1), respectively. Conclusion: 5-7 days after splenectomy, PLT 鈮，

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