Logistic回归分析急性白血病患儿诱导化疗期PICC相关血栓的影响因素及防治策略

目的 采用Logistic回归分析急性白血病患儿诱导化疗期中心静脉导管（areas under the curve，PICC）相关血栓的影响因素。方法 回顾性选取急性白血病患儿184例，根据诱导化疗期（置管后15 d）导管部位超声检查是否发现血栓分为血栓组（38例）与无血栓组（146例）。收集2组临床资料，采用单因素、Logistic回归多因素分析急性白血病患儿诱导化疗期PICC相关血栓的影响因素，并采用受试者工作特征（areas under the curve，ROC）曲线评价Logistic多因素回归模型对急性白血病患儿诱导化疗期PICC相关血栓的预测价值。结果 2组年龄、性别、疾病类型、疾病危险度、置管静脉、置管时白细胞（white blood cell,WBC）、血小板计数（platelet count，PLT）、D二聚体 (D dimer,D-D)、凝血酶原时间(prothrombin time，PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、置管后15 d WBC、PLT、PT、APTT水平比较差异无统计学意义（P＞0.05）；2组置管位置、合并导管相关感染、使用止血药物、置管后15 d D-D水平比较差异有统计学意义（P＜0.05）。Logistic回归多因素分析，右侧置管、合并导管相关感染、使用止血药物、置管后15 d D-D水平过高是急性白血病患儿诱导化疗期PICC相关血栓的独立危险因素（P＜0.05）；ROC曲线分析，Logistic多因素回归模型对急性白血病患儿诱导化疗期PICC相关血栓的预测AUC为0.917，95%CI：0.866~0.954，敏感度为84.21%，特异度为84.44%。结论 急性白血病患儿诱导化疗期PICC相关血栓的独立危险因素较多，构建Logistic多因素回归模型预测价值可靠，有利于降低PICC相关血栓发生风险。

Logistic regression analysis of influencing factors and prevention and treatment strategies for PICC-related thrombosis during induction chemotherapy in children with acute leukemia

Objective To analyze the influencing factors of peripherally inserted central catheter (PICC)-related thrombosis during induction chemotherapy in children with acute leukemia by Logistic regression analysis.Methods A total of 184 children with acute leukemia were retrospective selected. According to the presence or absence of thrombosis at the catheter site during induction chemotherapy period(at 15 d after catheter placement), they were divided into thrombus group(n=38) and the non-thrombosis group(n=146). The clinical data of the two groups were collected, and univariate and multivariate Logistic regression analyses were used to analyze the influencing factors of PICC-related thrombosis during induction chemotherapy in children with acute leukemia. The receiver operating characteristic(ROC) curve was used to evaluate the predictive value of multivariate Logistic regression model in PICC-related thrombosis in children with acute leukemia during induction chemotherapy.Results There was no significant difference between two groups in age, sex, disease type, disease risk, vein catheterization, as well as white blood cell(WBC), platelet(PLT), D-dimer(D-D), prothrombin time(PT), and activated partial thromboplastin time(APTT) at the time of catheterization, and WBC, PLT, PT and APTT at 15 d after catheterization(P＞0.05). There were significant differences in catheter placement, catheter-related infection, use of hemostatic drugs and D-D level at 15 d after catheterization between two groups(P＜0.05). Multivariate Logistic regression analysis showed that right-sided catheterization, catheter-related infection, use of hemostatic drugs, and high D-D level at 15 d after catheterization were independent risk factors for PICC-related thrombosis in children with acute leukemia during induction chemotherapy(P＜0.05). ROC curve analysis showed that the area under the ROC curve(AUC) of multivariate Logistic regression model in predicting PICC-related thrombosis in children with acute leukemia during induction chemotherapy was 0.917, 95%CI was 0.866 to 0.954, sensitivity was 84.21%, and specificity was 84.44%.Conclusion There are a number of independent risk factors for PICC-related thrombosis during induction chemotherapy in children with acute leukemia. Multivariate Logistic regression model has a reliable predictive value, which is conductive to reduction of the risk of PICC-related thrombosis.