[Analysis of Risk Factors and Construction of Predictive Model for Iliac Vein Compression Syndrome Combined with Deep Vein Thrombosis of the Lower Extremities].

摘要

OBJECTIVE: To explore the risk factors of lower extremity deep vein thrombosis (DVT) in patients with iliac vein compression syndrome (IVCS) and to construct a risk prediction model. METHODS: A total of 187 patients with IVCS admitted to The First Hospital of Lanzhou University from January 2023 to December 2024 were selected as the research subjects. Clinical data such as gender, age, underlying diseases, surgical history, anticoagulation history, body mass index (BMI), and laboratory test results of all patients were collected. According to whether the patients were combined with lower extremity DVT, they were divided into the DVT group (90 cases) and the non-DVT group (97 cases). Univariate and multivariate Logistic regression analyses were used to analyze the risk factors of lower extremity DVT in patients with IVCS. One hundred patients with IVCS admitted to our hospital from January 2025 to July 2025 were selected as the validation group for model validation. The Hosmer-Lemeshow test was used to evaluate the goodness-of-fit of the model, and the predictive performance of the model was evaluated based on the area under the receiver operating characteristic (ROC) curve (AUC). RESULTS: There were statistically significant differences between the DVT group and the non-DVT group in terms of age, BMI, lower extremity mobility disorder, postoperative infection, previous history of thrombosis, D-dimer levels, anticoagulation history, bed rest time, uric acid levels, prothrombin time, and fibrinogen levels (P < 0.05). Multivariate Logistic regression analysis revealed advanced age (OR =1.107, 95%CI : 1.033-1.187, P =0.004), plasma D-dimer >0.5 mg/L (OR =12.799, 95%CI : 1.124-145.782, P =0.040), BMI >25 kg/m2 (OR =5.695, 95%CI : 1.474-22.008, P =0.012), previous history of thrombosis (OR =40.453, 95%CI : 7.234-226.214, P < 0.001), no history of anticoagulation (OR =8.020, 95%CI : 2.274-28.279, P =0.001), bed rest time >72 hours (OR =38.500, 95%CI : 2.696-549.888, P =0.007), hyperuricemia (OR =1.026, 95%CI : 1.016-1.035, P < 0.001) and hyperfibrinogen (OR =3.786, 95%CI : 1.366-10.491, P =0.010) were independent risk factor for lower extremity DVT in patients with IVCS. The Hosmer-Lemeshow test showed that, χ2 =9.608, the P value was 0.294, the goodness-of-fit of the model was good. ROC curve analysis showed that the AUC of the model was 0.946 (95%CI : 0.914-0.978), the specificity was 0.918, and the sensitivity was 0.833. The prediction accuracy of this model was 90.00%, and the Kappa consistency coefficient was 0.780. CONCLUSION: Advanced age, elevated D-dimer, BMI >25 kg/m2, previous history of thrombosis, no anticoagulation prevention, bed rest time >72 hours, hyperuricemia and hyperfibrinogen are all independent risk factors for lower extremity DVT in patients with IVCS. In clinical work, these factors should be emphasized and active intervention measures should be taken to prevent the occurrence of lower extremity DVT, and improve the prognosis of diseases. 题目: .髂静脉受压综合征合并下肢深静脉血栓的危险因素分析及预测模型构建. 目的: 探讨髂静脉受压综合征（IVCS）发生下肢深静脉血栓（DVT）的危险因素并构建预测模型。. 方法: 以兰州大学第一医院2023年1月－2024年12月收治的187例IVCS为研究对象，收集患者性别、年龄、身体质量指数（BMI）、基础疾病、手术史、抗凝史、实验室检验结果等临床资料；根据患者是否合并下肢DVT分为DVT组（90例）和非DVT组（97例）；采用单因素和多因素Logistic回归分析IVCS患者发生下肢DVT的危险因素。选取2025年1月－2025年7月本院收治的100例IVCS患者作为验证组，进行模型验证。. 结果: DVT组和非DVT组患者在年龄、BMI、下肢活动障碍、术后感染、既往血栓病史、D-二聚体、抗凝史、卧床时间、尿酸、凝血酶原时间、纤维蛋白原方面差异具有统计学意义（P < 0.05）。多因素Logistic回归分析发现高龄（OR =1.107，95%CI ：1.033-1.187，P =0.004）、血浆D-二聚体＞0.5 mg/L（OR =12.799，95%CI ：1.124-145.782，P =0.040）、BMI＞25 kg/m2 （OR =5.695，95%CI ：1.474-22.008，P =0.012）、既往血栓病史（OR =40.453，95%CI ：7.234-226.214，P < 0.001）、无抗凝史（OR =8.020，95%CI ：2.274-28.279，P =0.001）、卧床时间＞72 h（OR =38.500，95%CI ：2.696-549.888，P =0.007）、高尿酸（OR =1.026，95%CI ：1.016-1.035，P < 0.001）和高纤维蛋白原（OR =3.786，95%CI ：1.366-10.491，P =0.010）是IVCS患者发生下肢DVT的独立危险因素。Hosmer-Lemeshow检验结果显示模型拟合良好（χ2 =9.608，P =0.294）。ROC曲线分析该模型的AUC为0.946（95%CI ：0.914-0.978），特异度为0.918，敏感度为0.833。模型预测准确率为90.00%，Kappa一致性系数为0.780。. 结论: 高龄、D-二聚体升高、BMI＞25 kg/m2 、既往血栓病史、未进行抗凝预防、卧床时间＞72 h、高尿酸和高纤维蛋白原均是IVCS患者发生下肢DVT的独立危险因素，临床工作中应当重视这些因素，采取积极干预措施以预防下肢DVT发生，改善疾病预后。.