【摘要】：目的：探討肝硬化門靜脈高壓癥脾切除術后門靜脈血栓(portal venous system thrombosis PVT)形成危險因素并建立Logistic回歸預測模型,評價該模型對于判斷脾切除術后形成PVT的預測價值。方法：收集新疆醫(yī)科大學第一附屬醫(yī)院2009-01-01/2013-12-31期間因肝硬化門靜脈高壓導致脾功能亢進和/或食道胃底靜脈曲張行脾切除術治療患者的圍手術期臨床資料,以術后2周是否發(fā)生PVT為標準分組,對圍術期相關臨床危險因素進行單因素分析和多因素Logistic回歸分析,根據(jù)多因素分析結果建立Logistic回歸預測模型,繪制術后2周PVT形成風險情況的ROC曲線,評價該模型對于判斷術后形成PVT風險的預測價值。結果：多因素結果分析顯示術后5-7天血小板計數(shù)(PLT)、血小板體積(mean platelet volume MPV)、D-二聚體(D-Dimer)為術后2周患者發(fā)生PVT的獨立危險因素,術后使用抗凝藥物(usage of anticoagulation therapy UAT)、術后使用降低門靜脈壓力藥物(usage of reducing portal pressure therapy URPT)為術后2周患者發(fā)生PVT的獨立保護因素,根據(jù)上述指標建立Logistic回歸預測模型：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,準確度為84.03%,而方程中的各獨立危險因素PLT、MPV、D-Dimer所對應的界值點分別為4.42×1011/L、13.30 fL、2.55mg/L。結論：本項研究得出脾切除術后5-7天當PLT≥4.42×1011/L、MPV≥ 13.30fL、D-Dimer≥2.55mg/L將明顯增加PVT發(fā)生風險,術后UAT和URPT可以有效減少PVT的發(fā)生,對判斷肝硬化脾切除術后2周形成PVT的風險建立了準確性達到84.03%的預測模型,該模型靈敏度、特異度、準確度高,我們的模型對于圍術期選擇合理的干預方法預防PVT形成提供了明確的數(shù)學模型及臨界值,進一步驗證其準確性具有重要的臨床意義和價值。
[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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