老年住院病人下肢远端深静脉血栓形成风险预测模型构建

doi:10.3969/j.issn.1003-9198.2025.11.017

摘要/Abstract

摘要： 目的构建老年住院病人下肢远端深静脉血栓形成(DDVT)的风险预测模型。方法选取2020年1月至2023年10月期间入住上海交通大学医学院附属瑞金医院老年病科的老年病人共621例,收集基本资料、疾病情况以及血液学指标。采用LASSO回归及多因素logistic回归筛选预测因素,构建风险预测模型,绘制诺谟图(Nomogram),并采用一致性指数、校准曲线、临床决策曲线来评价模型的效能。结果共172例病人发生DDVT。经过筛选,共有11项预测因素纳入模型:性别、近3个月内大手术、急性脑卒中、活动性恶性肿瘤、长期应用糖皮质激素、近4周内急性感染、卧床或制动≥72 h、心力衰竭、D-二聚体≥0.55 mg/L、纤维蛋白降解产物(fibrin degradation products, FDP)≥5.0 mg/L、癌抗原125(CA125)>24 U/L。Nomogram显示模型具有较好的区分度(C指数=0.930,95%CI: 0.909~0.951),校准曲线与理想曲线接近重合,决策曲线提示模型的临床净收益率显著优于“全阳性”与“全阴性”。结论本研究建立的老年住院病人DDVT风险预测模型具有良好的区分度、一致性和临床效益,可以有效预测老年住院病人罹患DDVT的风险,快速识别DDVT高危人群,为老年病人DDVT的早期预测及干预提供了直观有效的指导工具。

关键词: 老年住院病人, 下肢远端深静脉血栓形成, 预测模型

Abstract: Objective To identify the independent risk factors for lower extremity distal deep vein thrombosis (DDVT) in the elderly inpatients and to establish a nomogram prediction model. Methods The clinical data of 621 elderly inpatients from Department of Geriatrics, Ruijin Hospital were collected, and LASSO and multivariate logistic regression analysis were used to identify the independent risk factors for DDVT. In this way, a nomogram prediction model was established. Receiver operating characteristic curve analysis was used to calculate the area under the curve, and calibration and decision curves were plotted to assess the predictive performance of the model. Results A total of 621 elderly inpatients were enrolled, and 172 (27.70%) cases presented with lower extremity DDVT. Eleven predictors were identified as independent risk factors for lower extremity DDVT in elderly inpatients by multivariate logistic regression analysis, including gender(male), surgery within three months, acute cerebral stroke, active malignant tumor, long-term use of corticosteroids, acute infection in four weeks, immobility in 72 hours, heart failure, D-dimer≥0.55 mg/L, fibrin degradation products(FDP)≥5.0 mg/L, CA125>24 U/L. C index was 0.930(95%CI: 0.909－0.951), which showed good discrimination. The calibration curve and decision analysis curve indicated good predictive performance and clinical benefit. Conclusions The established prediction model has a high accuracy in predicting the risk of lower extremity DDVT in the elderly inpatients, providing an effective tool for clinicians to identify high-risk patients and implement early intervention.

Key words: elderly inpatient, distal deep vein thrombosis, predictive model

中图分类号:

R 543.6

张伊融, 吴方. 老年住院病人下肢远端深静脉血栓形成风险预测模型构建[J]. 实用老年医学, 2025, 39(11): 1156-1162.

ZHANG Yirong, WU Fang. Establishment of a risk prediction model for distal deep vein thrombosis in elderly inpatients[J]. Practical Geriatrics, 2025, 39(11): 1156-1162.

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