乳腺癌术后下肢深静脉血栓形成的危险因素分析和列线图预测模型构建

摘要

探讨乳腺癌患者手术后下肢深静脉血栓形成的危险因素并构建列线图预测模型。收集2014年1月至2024年1月于临沂市人民医院手术治疗的320例乳腺癌患者的临床资料，根据术后1个月内是否发生下肢深静脉血栓分为血栓组和非血栓组。比较两组患者的临床资料，采用Logistic回归分析评估乳腺癌术后下肢深静脉血栓形成的影响因素。基于影响因素构建列线图预测模型，采用受试者工作特征（ROC）曲线、校正曲线和临床决策曲线评估模型的预测效能。两组患者的年龄、BMI、糖尿病史、肿瘤长径、肿瘤分期、手术时间、术后放疗、Caprini评分、总胆固醇水平、甘油三酯水平、低密度脂蛋白水平、活化部分凝血酶原时间以及D-二聚体水平比较，差异均有统计学意义（P＜0.05）。多因素Logistic回归分析显示，BMI、糖尿病史、肿瘤长径、肿瘤分期、手术时间、术后放疗、Caprini评分、甘油三酯水平、低密度脂蛋白水平、活化部分凝血酶原时间和D-二聚体水平均是乳腺癌术后下肢深静脉血栓形成的独立预测因素。基于以上独立因素构建列线图预测模型，ROC曲线下面积（AUC）为0.846，表明预测模型具有良好的区分能力。校正曲线与理想曲线贴合度较好（C-index为0.879），提示预测模型具有较高的准确性。临床决策曲线显示，预测模型具有较好的临床净收益。基于独立因素构建的列线图预测模型能够帮助临床医师快速、简便地识别乳腺癌术后下肢深静脉血栓形成的高危患者，从而进行早期预防和干预。

关键词

乳腺癌 / 下肢深静脉血栓 / 影响因素 / 列线图预测模型

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基金资助

山东省医学会乳腺疾病科研专项资金重点项目(YXH2021ZX050)