| 赵浩,田志龙.下肢动脉血管重建术后并发淋巴漏的风险预测列线图模型建立及预防指导[J].安徽医药,2024,28(4):821-825. |
| 下肢动脉血管重建术后并发淋巴漏的风险预测列线图模型建立及预防指导 |
| Establishment of nomogram model for risk prediction of lymphatic leakage after arterial revascularization of lower extremities and guidance for its prevention |
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| DOI：10.3969/j.issn.1009-6469.2024.04.040 |
| 中文关键词: 血管成形术 下肢动脉硬化闭塞症 血管重建 淋巴漏 列线图模型 风险预测 |
| 英文关键词: Angioplasty Lower extremity arteriosclerosis obliteran Revascularization Lymphatic leakage Nomogram mod?el Risk prediction |
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| 摘要点击次数: 173 |
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| 中文摘要: |
| 目的探讨下肢动脉血管重建术后并发淋巴漏的影响因素，并以此构建风险预测列线图模型，同时提出相对应的预防指导建议。方法回顾性分析于 2014年 1月至 2022年 6月在徐州市中心医院行下肢动脉血管重建的 879例下肢动脉硬化闭塞症( LEASO)病人的临床资料，根据病人术后有无并发淋巴漏将其分为并发组( 31例)和未并发组( 848例)比较两组病人的一般资料。采用多因素 logistic回归分析法分析下肢动脉血管重建术后并发淋巴漏的影响因素，并基于此采用，R 3.4.5软件包绘制列线图模型，且绘制受试者工作特征( ROC)曲线对列线图模型的预测效能进行评估，绘制校准度曲线图并采用 Bootstrap法检验预测列线图预测模型的一致性。结果单因素分析显示，两组身体质量指数( BMI)［(26.52±2.01)kg/m2比( 25.71±2.13) kg/m2］及 Fontaine分期［Ⅳ期 38.71%比 18.28%］、术中出血量［>100 mL 29.03%比 11.20%］、术后血红蛋白( Hb)水平［( 95.33±15.25)g/L比( 104.57±22.38)g/L］、术后白蛋白( Alb)水平［( 25.68±5.59)g/L比( 28.28±6.17)g/L］、使用高频电刀( 83.87%比55.54%)、腹股沟切口( 80.65%比 56.25%)差异有统计学意义(均 P<0.05)。 logistic回归分析可知， BMI［OR=2.52，95%CI:(1.18，3.86)］、 Fontaine分期［OR=3.22，95%CI:(2.08，4.36)］、术中出血量 >100 mL［OR=3.36，95%CI:(2.23，4.48)］、术后 Hb水平［OR=2.97，95%CI:(1.75，4.20)］、术后 Alb水平［OR=3.10，95%CI:(2.02，4.19)］、使用高频电刀［OR=3.39，95%CI:(2.20，4.59)］、腹股沟切口［OR=3.31，95%CI:(2.00，4.62)］均是影响 LEASO病人下肢动脉血管重建术后并发淋巴漏的独立危险因素(P<0.05)。据此构建预测 LEASO病人下肢动脉血管重建术后并发淋巴漏的列线图模型，预测值同实测值基本一致，一致性指数为 0.836，模型具有良好的精准度和区分度。结论 BMI、Fontaine分期、术中出血量 >100 mL、术后 Hb水平、术后 Alb水平、使用高频电刀、腹股沟切口均为影响 LEASO病人下肢动脉血管重建术后并发淋巴漏的影响因素，基于上述因素构建的列线图模型效能高。 |
| 英文摘要: |
| Objective To explore the influencing factors of lymphatic leakage after lower extremity arterial revascularization, to estab?lish a risk prediction nomograph model, and to propose corresponding prevention guidance suggestions.Methods The clinical data of 879 patients with lower extremity arteriosclerosis obliteran (LEASO) who underwent lower extremity arterial revascularization in Xu?zhou Central Hospital from January 2014 to June 2022 were retrospectively analyzed. The patients were assigned into the complicationgroup (31 cases) and the non-complication group (848 cases) according to whether with lymph leakage after surgery, and the general da?ta of the two groups were compared. Multivariate logistic regression analysis was used to analyze the influencing factors of lymphaticleakage after lower extremity arterial revascularization, and R3.4.5 software package was used to draw the nomogram model based onthis, and the receiver operating characteristic (ROC) curve was drawn to evaluate the prediction efficiency of the nomogram model, andthe calibration curve was drawn, and Bootstrap method was used to test the consistency of the nomogram prediction model. Results Univariate analysis showed that body mass index (BMI) [(26.52±2.01) kg/m2 vs. (25.71±2.13) kg/m2], Fontaine stage ( Ⅳ 38.71% vs. 18.28%), intraoperative blood loss >100 mL (29.03% vs. 11.20%), postoperative hemoglobin (Hb) level [(95.33±15.25) g/L vs. (104.57± 22.38) g/L], postoperative albumin (Alb) level [(25.68±5.59) g/L vs. (28.28±6.17) g/L], use of high frequency electric knife (83.87% vs. 55.54%), inguinal incision (80.65% vs. 56.25%) of the two groups had statistical significance (P<0.05). Logistic regression analysis showed that BMI [OR=2.52, 95%CI:(1.18, 3.86)], Fontaine stage [OR=3.22, 95%CI: (2.08, 4.36)], intraoperative blood loss >100 mL [OR=3.36, 95%CI: (2.23, 4.48)], postoperative Hb level [OR=2.97, 95%CI: (1.75, 4.20)], postoperative Alb level [OR=3.10, 95%CI:(2.02, 4.19)], use of high frequency electric knife [OR=3.39, 95%CI: (2.20, 4.59), and inguinal incision [OR=3.31, 95%CI: (2.00, 4.62)] were independent risk factors for lymphatic leakage after lower extremity arterial revascularization in LEASO patients (P<0.05). On thisbasis, a nomograph model was constructed to predict lymphatic leakage after lower extremity arterial revascularization in LEASO pa?tients. The validation model results showed that the predicted value was basically consistent with the measured value, and the consis?tency index (C-index value) was 0.836, indicating that the model had good accuracy and discrimination.Conclusion BMI, Fontainestage, intraoperative blood loss>100 mL, postoperative Hb level, postoperative Alb level, use of high frequency electric knife and ingui?nal incision are all influencing factors for LEASO patients with lymphatic leakage after arterial revascularization of lower extremities.The nomogram constructed based on the above factors has high efficiency. |
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