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| 前列腺冷冻消融术后高凝状态的危险因素分析和列线图模型建立 |
| Risk factors and nomogram model establishment for postoperative hypercoagulable state in patients undergoing prostate cryoablation |
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| DOI：10.12089/jca.2025.04.006 |
| 中文关键词: 术后高凝状态 前列腺癌 冷冻消融术 危险因素 列线图 |
| 英文关键词: Postoperative hypercoagulable state Prostate cancer Cryoablation Risk factors Nomograms |
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| 中文摘要: |
目的：分析前列腺冷冻消融术后高凝状态（PHCS）发生的危险因素，并构建可视化的列线图模型。
方法：选择择期行全麻下前列腺冷冻消融术的局限性前列腺癌患者198例，年龄18～85岁，BMI 18.5～32.0 kg/m 2，ASA Ⅰ或Ⅱ级。以术后第1天有无PHCS将患者分为两组：高凝状态组（HC组）和非高凝状态组（NHC组）。分析术前新辅助治疗史、手术时间、输液量、术中用药，术前1周内的高敏C反应蛋白（hs-CRP），白细胞计数、血红蛋白（Hb）、血小板计数（Plt），活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原（Fib）、凝血酶时间（TT）、D-二聚体（D-D），IL-1β、 IL-2受体、IL-6、IL-8、肿瘤坏死因子（TNF-α）及睾酮含量等。采用多因素Logistic回归分析前列腺冷冻消融术PHCS的危险因素，并建立列线图预测模型。采用受试者工作特征（ROC）曲线、校准曲线、决策曲线分析（DCA）对模型进行评估。
结果：术后第1天发生PHCS的患者共有76例（38.4%）。与NHC组比较，HC组使用右美托咪定比例、Hb、APTT、TT明显降低（P<0.05），合并高血压、术前新辅助治疗、IL-1β≥5 ng/L比例、Plt明显升高（P<0.05）。多因素Logistic回归分析显示，术前高血压（OR=2.112， 95%CI 1.063～4.199， P=0.033），术前新辅助治疗（OR＝2.173，95%CI 1.083～4.361，P=0.029），Plt升高（OR＝1.007，95%CI 1.001～1.014，P=0.028）是前列腺冷冻消融术PHCS的独立危险因素。APTT延长（OR＝0.812，95%CI 0.691～0.955，P=0.012），TT延长（OR＝0.743，95%CI 0.575～0.959，P=0.022）是前列腺冷冻消融术PHCS的独立保护因素。ROC曲线显示，该预测模型预测前列腺冷冻消融术后PHCS风险的曲线下面积（AUC）为0.75（95%CI 0.68～0.82）。校准曲线显示，预测曲线与实测曲线基本吻合。DCA结果显示，该列线图模型在预测前列腺冷冻消融术患者PCHS方面能产生良好的临床效益。
结论：术前高血压、术前新辅助治疗、较高的Plt是前列腺冷冻消融术后发生PHCS的独立危险因素，APTT和TT延长是发生PHCS的独立保护因素，基于以上因素建立的列线图模型可有效预测前列腺冷冻消融术患者术后第1天PHCS的风险。 |
| 英文摘要: |
Objective: To identify the risk factors of postoperative hypercoagulable state (PHCS) and to establish a visual nomogram model with prostate cancer undergoing cryoablation.
Methods: A total of 198 patients with localized prostate cancer who underwent cryoablation, aged 18-85 years, BMI 18.5-32.0 kg/m 2, ASA physical status Ⅰ or Ⅱ were selected. Patients were divided into two groups according to whether there was PHCS the day after operation: the PHCS group (group HC) and the non-PHCS group (group NHC). Preoperative neoadjuvant therapy, surgical time, intraoperative infusion volume, intraoperative drugs, hypersensitive C-reactive protein (hs-CRP), complete blood count including white blood cell, hemoglobin (Hb), platelet (Plt), coagulation function including activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (Fib), thrombin time (TT), D-dimer (D-D), inflammatory factors including IL-1β, IL-2 receptor, IL-6, IL-8, TNF-α and testosterone within one week before operation were recorded. Multivariate Logistic regression analysis was performed to determine the independent risk factors for PHCS, a nomogram model was established. The nomogram model was validated using receiver operating characteristic (ROC) curve, calibration curves, and decision curve analysis (DCA).
Results: 76(38.4%) patients developed PHCS on the day after the operation. Compared with group NHC, proportion of patients who used dexmedetomidine, Hb, APTT, TT were significantly lower (P < 0.05), while patients with hypertension, preoperative neoadjuvant therapy, proportion of IL-1β ≥ 5 ng/L and Plt were significantly higher in group HC (P < 0.05). Multivariate Logistic regression analysis showed that preoperative hypertension (OR = 2.112, 95% CI 1.063-4.199, P = 0.033), preoperative neoadjuvant therapy (OR = 2.173, 95% CI 1.083-4.361, P = 0.029), high Plt (OR = 1.007, 95% CI 1.001-1.014, P = 0.028) were independent risk factors for PHCS after prostate cryoablation. Prolonged APTT (OR = 0.812, 95% CI 0.691-0.955, P = 0.012) and prolonged TT (OR = 0.743, 95% CI 0.575-0.959, P = 0.022) were independent protective factors for PHCS after prostate cryoablation. A nomogram model was developed based on these risk factors to predict PCHS after prostate cryoablation. The area under the curve (AUC) of the ROC curve was 0.75 (95% CI 0.68-0.82), the calibration curve results indicated that the predicted curve of the nomogram model closely matched the observed outcomes. DCA showed that the nomogram model provided good clinical benefit in predicting PCHS after prostate cryoablation.
Conclusion: Preoperative hypertension, preoperative neoadjuvant therapy, high Plt were independent risk factors for PHCS after prostate cryoablation. Prolonged APTT and TT were independent protective factors for PHCS. The nomogram model based on these factors had high predictive accuracy for PHCS after prostate cryoablation. |
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