肺癌化疗病人发生PICC相关上肢静脉血栓风险Nomogram模型的构建

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Establishment of a Nomogram model to individually predict the risk of PICC⁃associated upper limb venous thrombosis in patients undergoing chemotherapy for lung cancer

WANG Huiping， CAO Ying

The First Affiliated Hospital of Nanchang University， Jiangxi 330006 China

Corresponding Author  CAO Ying， E⁃mail： caoyinglxy@163.com

Abstract  Objective：To investigate the risk factors of peripherally inserted central catheter（PICC） related upper limb venous thrombosis in lung cancer patients undergoing chemotherapy，construct a Nomogram model of the risk，and further verify the predictive value of this model.Methods：A total of 391 patients with primary lung cancer undergoing chemotherapy in the Department of Respiratory Medicine of our hospital from January 2014 to December 2020 were selected.The clinical data of the patients were compared and the independent risk factors of PICC⁃related upper limb venous thrombosis in patients with lung cancer undergoing chemotherapy were analyzed by multivariate Logistic regression model.R software integrates independent risk factors and constructs Nomogram models.Results：PICC-related upper limb vein thrombosis occurred in 89 patients（22.76%） receiving chemotherapy for lung cancer.BMI（≥27.49 kg/m2），diabetes（yes），FIB（≥3.60 g/L），APTT（≥33 s），D⁃D（≥0.90 mg/L） and CRP （≥5.80 mg/L） were independent risk factors for PICC⁃related upper limb venous thrombosis in patients with lung cancer chemotherapy（P<0.05）.The prediction of this Nomogram model is in good agreement with the actual observation，with a C⁃index of 0.832（95%CI 0.793⁃0.866），When the risk threshold is>0.05，this Nomogram model can provide additional clinical net benefit over individual risk factors in predicting the high risk of PICC related upper limb venous thrombosis in lung cancer chemotherapy patients.Conclusion：This Nomogram model based on BMI，diabetes，FIB，APTT，D⁃D，CRP and other independent risk factors is feasible to predict PICC⁃related upper limb venous thrombosis in patients with lung cancer chemotherapy，and can provide a important reference for clinical risk stratification and nursing strategy.

Keywords  lung cancer； chemotherapy； peripherally inserted central catheter； upper limb venous thrombosis； Nomogram model；influencing factor

摘要  目的：探究肺癌化疗病人发生经外周静脉置入中心静脉导管（PICC）相关上肢静脉血栓的危险因素，构建其风险Nomogram模型，并进一步验证该模型的预测价值。（剩余10706字）