2022 年第 10 期 第 17 卷

肺癌胸腔镜术后静脉血栓栓塞发生的危险因素及预测模型的构建

Risk factors and prediction model construction for venous thromboembolism in patients after thoracoscopic surgery for lung cancer

作者：张鑫骆宝建韩芬刘秋月

英文作者：Zhang Xin Luo Baojian Han Fen Liu Qiuyue

单位：首都医科大学附属北京胸科医院重症医学科北京市结核病胸部肿瘤研究所，北京101149

英文单位：Department of Intensive Care Unit Beijing Chest Hospital Capital Medical University Beijing Tuberculosis and Thoracic Tumor Research Institute Beijing 101149 China

关键词：肺癌；胸腔镜；静脉血栓栓塞；预测模型

英文关键词：Lungcancer;Thoracoscopy;Venousthromboembolism;Predictionmodel

• 摘要：

• 目的 寻找肺癌胸腔镜手术患者术后发生静脉血栓栓塞（VTE）的危险因素，并构建VTE的预测模型。方法 回顾性选取2017年1月至2021年12月在首都医科大学附属北京胸科医院接受肺癌胸腔镜手术术后发生VTE患者59例为VTE组，纳入同期肺癌胸腔镜手术后未发生VTE患者59例为对照组。比较2组临床资料。采用多因素Logistic回归方法分析肺癌胸腔镜手术患者术后发生VTE的危险因素，并根据危险因素构建患者术后发生VTE的风险预测模型。采用受试者工作特征（ROC）曲线评价预测模型的应用价值。结果 VTE组糖尿病比例，术前丙氨酸转氨酶、纤维蛋白原、D-二聚体、癌胚抗原水平，手术时间、术中出血量、术后8 h D-二聚体水平均高于对照组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示，术前癌胚抗原水平、手术时间及术后8 h D-二聚体水平是肺癌胸腔镜手术患者术后发生VTE的独立危险因素（比值比=1.078、1.207、1.754，95%置信区间：1.040～1.113、1.057～1.328、1.588～1.812，P=0.033、0.003、＜0.001）。建立VTE预测模型，Y=-3.710-0.068×术前癌胚抗原水平-0.003×手术时间-0.221×术后8 h D-二聚体水平。ROC曲线分析结果显示，预测模型对肺癌胸腔镜手术患者术后发生VTE的敏感度为83.1%，特异度为83.2%，曲线下面积为0.902。结论 术前癌胚抗原水平高、手术时间长及术后8 h D-二聚体水平高的肺癌胸腔镜手术患者术后发生VTE的风险较高。此VTE风险预测模型对肺癌胸腔镜手术患者术后发生VTE的风险具有较好的预测能力。

• Objective  To find out the risk factors of venous thromboembolism (VTE) in patients after thoracoscopic surgery for lung cancer, and to establish a predictive model of VTE. Methods Totally 59 patients with VTE after thoracoscopic surgery for lung cancer in Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University from January 2017 to December 2021 were retrospectively enrolled as the VTE group, and 59 patients without VTE after thoracoscopic surgery for lung cancer in the same period were enrolled as the control group. The clinical data of the two groups were compared. Multivariate Logistic regression method was used to analyze the risk factors of postoperative VTE in patients with lung cancer undergoing thoracoscopic surgery, and the risk prediction model of postoperative VTE in patients was constructed according to the risk factors. The receiver operating characteristic (ROC) curve was used to evaluate the application value of the prediction model. Results The proportion of diabetes, the preoperative levels of alanine aminotransferase, fibrinogen, D-dimer and carcinoembryonic antigen (CEA), the operative duration, the amount of bleeding during operation and the level of D-dimer 8 h after operation in the VTE group were higher than those in the control group(all P＜0.05). Multivariate Logistic regression analysis showed that the preoperative level of CEA, operative duration and the level of D-dimer 8 h after operation were independent risk factors for postoperative VTE in patients with lung cancer undergoing thoracoscopic surgery (odds ratio=1.078, 1.207, 1.754, 95% confidence interval: 1.040-1.113, 1.057-1.328, 1.588-1.812, P=0.033, 0.003, ＜0.001). The VTE prediction model was established, Y=-3.710-0.068×preoperative level of CEA-0.003×operative duration-0.221×level of D-dimer 8 h after operation. ROC curve analysis showed that the sensitivity, specificity and area under the curve of the prediction model for postoperative VTE in patients with lung cancer undergoing thoracoscopic surgery were 83.1%, 83.2% and 0.902, respectively. Conclusions High preoperative level of CEA, long operative duration, and high level of D-dimmer 8 h after operation were independent risk factors for VTE in patients with thoracoscopic surgery for lung cancer. This VTE risk prediction model has a good ability to predict the risk of postoperative VTE in patients with lung cancer undergoing thoracoscopic surgery.