乳腺癌PICC化疗患者发生静脉血栓相关影响因素的回归分析-东南大学学报医学版

乳腺癌PICC化疗患者发生静脉血栓相关影响因素的回归分析

单位：南京医科大学附属淮安第一医院肿瘤内一科, 江苏淮安 223300

分类号：R737.9

出版年·卷·期（页码）：2025·44·第一期（121-126）

摘要：

目的:探讨乳腺癌经外周静脉置入中心静脉导管(PICC)化疗患者发生静脉血栓的有关影响因素,并构建预测模型。方法:回顾性选取2021年3月至2024年4月在本院行PICC化疗期间并发静脉血栓的乳腺癌患者52例为血栓组,同期未并发静脉血栓患者104例为对照组。采集两组一般人口学资料、疾病相关资料、置管资料、实验室资料,应用多因素Logistic回归分析观察乳腺癌PICC化疗患者发生静脉血栓的有关影响因素,建立预测模型,绘制校正曲线评价模型一致性,采用受试者工作特征(ROC)曲线评价模型区分度。结果:血栓组年龄≥60岁比例、合并糖尿病比例、置管前D-二聚体水平、血小板计数、C-反应蛋白水平均高于对照组(P＜0.05),穿刺静脉为贵要静脉的比例低于对照组(P＜0.05)。Logistic回归分析显示,年龄≥60岁、合并糖尿病、置管前D-二聚体高、C-反应蛋白高均为乳腺癌PICC化疗患者并发静脉血栓的危险因素,穿刺静脉为贵要静脉是保护因素(P＜0.05)。校正曲线显示,模型预测概率与实际概率较为接近,一致性良好。ROC曲线显示,模型预测乳腺癌PICC化疗患者发生静脉血栓的曲线下面积(AUC)为0.967,95%CI为0.940~0.994,预测敏感度为92.31%,特异度为93.27%,准确度为92.95%。结论:乳腺癌PICC化疗患者发生静脉血栓的影响因素为年龄、糖尿病、穿刺静脉、置管前D-二聚体、C-反应蛋白,且据此构建的预测模型预测效能良好。

Objective: To explore the factors influencing venous thrombosis in breast cancer patients undergoing chemotherapy with peripherally inserted central catheters(PICC) and to construct a prediction model. Methods:A retrospective study was conducted, including 52 breast cancer patients who developed venous thrombosis during PICC chemotherapy(thrombosis group) and 104 patients without thrombosis(control group) from March 2021 to April 2024 at our hospital. Demographic data, disease-related information, catheterization details, and laboratory findings were collected for both groups. Multivariate Logistic regression analysis was used to identify factors influencing venous thrombosis in breast cancer patients undergoing PICC chemotherapy. A prediction model was established, and its consistency was evaluated using a calibration curve. The model's discrimination was assessed using the receiver operating characteristic(ROC) curve. Results:The thrombosis group had higher proportions of patients aged ≥60 years and those with diabetes comorbidity, as well as higher levels of pre-catheterization D-dimer, platelet count, and C-reactive protein compared to the control group(P<0.05). The proportion of cephalic vein punctures was lower in the thrombosis group(P<0.05). Logistic regression analysis showed that age ≥60 years, diabetes comorbidity, elevated pre-catheterization D-dimer, and high C-reactive protein levels were risk factors for venous thrombosis in breast cancer patients undergoing PICC chemotherapy, while basilic vein puncture was identified was a protective factor(P<0.05). The prediction probability of the model was relatively close to the actual probability, with good consistency. The ROC curve analysis revealed an area under the curve(AUC) of 0.967(95%CI: 0.940-0.994) for predicting venous thrombosis with a sensitivity of 92.31%, specificity of 93.27%, and accuracy of 92.95%. Conclusion:The factors influencing venous thrombosis in breast cancer patients undergoing PICC chemotherapy include age, diabetes, choice of puncture vein, pre-catheterization D-dimer, and C-reactive protein. The prediction model constructed based on these factors demonstrates a good predictive performance.

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