糖尿病患者全膝关节置换术后下肢深静脉血栓形成相关危险因素分析

Analysis of Related Risk Factors for Deep Vein Thrombosis in the Lower Extremities in Diabetic Patients after Total Knee Arthroplasty

摘要: 目的：探讨糖尿病患者TKA术后下肢DVT相关危险因素。方法：选取糖尿病患者行全膝关节置换术的病例，按有无发生下肢深静脉血栓分成DVT组(34例)和n-DVT组(66例)。收集两组患者的一般临床资料，使用SPSS26.0软件，采用单因素分析及多因素Logistic回归分析确定DVT的危险因素，绘制ROC曲线分析两组患者不同指标的敏感度及特异性，确定各个指标单独检测及联合检测糖尿病患者TKA术后下肢DVT的价值性。结果：单因素分析结果显示DVT组在BMI、手术时间、止血带压力、术前CRP、纤维蛋白原、术后NEUT %水平方面，相较于n-DVT组均具有显著的差异性(P < 0.05)。多因素Logistic回归分析显示DVT组BMI (OR = 5.119, P = 0.011)、手术时间(OR = 7.632, P = 0.007)、止血带压力(OR = 5.456, P = 0.047)、术前CRP (OR = 1.112, P = 0.020)、纤维蛋白原(OR = 3.147, P = 0.005)、术后NEUT % (OR = 1.139, P = 0.015)水平较n-DVT组高，是糖尿病患者TKA术后下肢DVT的危险因素。ROC分析显示BMI、手术时间、止血带压力、术前CRP、纤维蛋白原、术后NEUT %水平联合检测预测糖尿病患者TKA术后下肢DVT的AUC为0.898，灵敏度为91.2%，特异度为85.3% (P < 0.05)，联合检测预测价值较高。结论：BMI、手术时间、止血带压力、术前CRP、纤维蛋白原、术后NEUT %水平高是糖尿病患者TKA术后下肢DVT的潜在危险因素，具有一定的预测价值，联合预测价值更高。本研究的结果为糖尿病患者TKA术后下肢DVT的评估及预防提供了一定参考价值。

Abstract: Objective: To explore the risk factors related to DVT after TKA in patients with diabetes. Methods: Selecting cases of diabetic patients undergoing TKA and divide them into two groups based on whether they developed lower extremity DVT: the DVT group (34 cases) and the non-DVT group (66 cases). Collecting general clinical data from both groups, using SPSS26.0 software, and employing univariate analysis and multivariate Logistic regression analysis to identify the risk factors for DVT. Constructing ROC curves to analyze the sensitivity and specificity of different indicators in both groups, and determining the value of individual and combined indicator testing for predicting lower extremity DVT in diabetic patients after TKA. Results: Single-factor analysis results show that the DVT group exhibited significant differences compared to the non-DVT group in terms of BMI, operation time, tourniquet pressure, preoperative CRP, fibrinogen levels, and postoperative NEUT % levels (P < 0.05). Multivariate Logistic regression analysis indicates that the DVT group had higher levels of BMI (OR = 5.119, P = 0.011), operation time (OR = 7.632, P = 0.007), tourniquet pressure (OR = 5.456, P = 0.047), preoperative CRP (OR = 1.112, P = 0.020), fibrinogen (OR = 3.147, P = 0.005), and postoperative NEUT % (OR = 1.139, P = 0.015) compared to the non-DVT group, which are risk factors for lower limb DVT after TKA in diabetic patients. ROC analysis shows that the combined detection of BMI, operation time, tourniquet pressure, preoperative CRP, fibrinogen, and postoperative NEUT % levels has a high predictive value for lower limb DVT after TKA in diabetic patients, with an AUC of 0.898, sensitivity of 91.2%, and specificity of 85.3% (P < 0.05). Conclusion: BMI, operation time, tourniquet pressure, preoperative CRP, fibrinogen, and elevated postoperative NEUT % levels are potential risk factors for lower limb DVT in diabetic patients undergoing TKA, with certain predictive value. The combined predictive value is even higher. The results of this study provide a reference for the assessment and prevention of lower limb DVT in diabetic patients after TKA.