基于凝血与血液流变学指标构建出血性脑卒中患者下肢深静脉血栓形成预测模型

Construction of a predictive model for lower extremity deep venous thrombosis in patients with hemorrhagic stroke based on coagulation and hemorheological indicators

摘要:

目的]探讨红细胞压积(HCT)、血浆D-二聚体联合纤维蛋白原(FIB)预测出血性脑卒中患者下肢深静脉血栓形成(DVT)的发生风险。 [方法]回顾性收集2023年1月至2025年6月合肥市第二人民医院收治的210例出血性脑卒中患者的临床资料,其中81例合并DVT(DVT组),129例无DVT(非DVT组)。外部验证队列选取同期收治的120例出血性脑卒中患者。采用多因素Logistic回归分析探究出血性脑卒中患者DVT的影响因素,并通过ROC曲线与校准曲线构建及验证相关预测模型。 [结果]DVT组年龄大于非DVT组,入院时NIHSS评分高于非DVT组,卧床时间长于非DVT组,HCT、FIB和D-二聚体水平高于非DVT组(P＜0.05),其余一般资料比较差异无统计学意义(P＞0.05)。多因素Logistic回归分析显示,入院时NIHSS评分较高(OR＝1.188,95%CI:1.066～1.324)、卧床时间较长(OR＝1.569,95%CI＝1.330～1.851)、HCT(OR＝1.209,95%CI:1.088～1.343)、FIB(OR＝2.733,95%CI:1.523～4.905)及D-二聚体水平较高(OR＝2.100,95%CI:1.219～3.617)均为出血性脑卒中患者发生DVT的独立危险因素(均P＜0.05)；联合入院时NIHSS评分、卧床时间、HCT、FIB及D-二聚体水平对出血性脑卒中患者DVT的预测AUC值高于各单项检测,差异均有统计学意义(均P＜0.05)。 [结论]入院时NIHSS评分较高、卧床时间较长、HCT、FIB及D-二聚体水平较高是出血性脑卒中患者发生DVT的独立危险因素,且这些指标的联合对出血性脑卒中患者DVT发生风险具有较高的预测价值。

Abstract:

Aim To explore the predictive value of hematocrit (HCT), plasma D-dimer combined with fibrinogen (FIB) for the risk of lower extremity deep venous thrombosis (DVT) in patients with hemorrhagic stroke. Methods Clinical data were retrospectively collected from 210 patients with hemorrhagic stroke admitted to the Second People's Hospital of Hefei from January 2023 to June 2025, including 81 patients with DVT (DVT group) and 129 patients without DVT (non-DVT group). 120 patients with hemorrhagic stroke admitted during the same period were enrolled as the external validation cohort. Multivariate Logistic regression was employed to identify influencing factors for DVT in hemorrhagic stroke, and ROC curves together with calibration curves were applied to establish and validate the predictive model. Results Patients in the DVT group were older, with higher admission NIHSS scores, longer bedridden duration, and elevated levels of HCT, FIB and D-dimer compared with the non-DVT group (P＜0.05). There was no statistically significant difference in other baseline data (P＞0.05). Multivariate Logistic regression analysis showed that elevated NIHSS scores (OR＝1.8,5%CI:1.066～1.324), prolonged bedridden duration (OR＝1.9,5%CI:1.330～1.851), increased HCT (OR＝1.9,5%CI:1.088～1.343), FIB (OR＝2.3,5%CI:1.523～4.905) and D-dimer (OR＝2.0,5%CI:1.219～3.617) at admission were independent risk factors for DVT in patients with hemorrhagic stroke (all P＜0.05); the combined detection of admission NIHSS score, bedridden duration, HCT, FIB and D-dimer yielded a higher AUC for predicting DVT than any single indicator, with statistically significant differences (all P＜0.05). Conclusion Elevated admission NIHSS score, prolonged bedridden duration, and increased HCT, FIB and D-dimer levels are independent risk factors for DVT in patients with hemorrhagic stroke; the combination of these indicators presents high predictive efficacy for DVT risk.