胃癌患者PICC置管后深静脉血栓形成与癌因性疲乏、衰弱状况的相关性分析-现代医学

胃癌患者PICC置管后深静脉血栓形成与癌因性疲乏、衰弱状况的相关性分析

单位：1. 中国人民解放军海军第九七一医院护理部, 山东青岛 266071;
2. 中国人民解放军海军第九七一医院肾脏病科, 山东青岛 266071;
3. 中国人民解放军海军第九七一医院肿瘤科, 山东青岛 266071

分类号：R543.6

出版年·卷·期（页码）：2026·54·第七期（1047-1055）

摘要：

目的：探究胃癌患者经外周静脉置入中心静脉导管(PICC)置管后深静脉血栓(DVT)形成与癌因性疲乏、衰弱状况的相关性。方法：纳入2020年12月至2025年12月中国人民解放军海军第九七一医院PICC置管的胃癌患者263例。依据置管后DVT形成状况分为无DVT组(228例)和DVT组(35例)。比较两组一般资料、衰弱状况及癌因性疲乏差异，多因素Logistic回归分析胃癌患者PICC置管后DVT形成的影响因素，分层Logistic回归分析衰弱状况、癌因性疲乏与胃癌患者PICC置管后DVT形成的相关性。通过受试者工作特征(ROC)曲线分析预测模型的预测价值。结果：多因素Logistic回归分析显示，肿瘤分期(≥Ⅲ期)、衰弱状况、D-二聚体(DD)、中性粒细胞与淋巴细胞比值(NLR)、血清白蛋白及Piper疲乏量表中文版(RPFS)评分均是胃癌患者PICC置管后DVT形成的独立影响因素(均P<0.05)。加入衰弱状况及RPFS评分后，模型拟合优度显著改善，预测正确率由88.2%升至96.6%。ROC曲线分析显示，肿瘤分期、衰弱状况、DD、NLR、血清白蛋白、RPFS评分、指标联合预测胃癌患者PICC置管后DVT形成的曲线下面积(AUC)分别为0.686、0.765、0.840、0.801、0.776、0.738、0.946，当取最佳cut-off值时，联合模型的灵敏度、特异度分别为0.857、0.947。结论：癌因性疲乏、衰弱状况是胃癌患者PICC置管后DVT形成的独立影响因素，基于二者构建的预测模型初步显示良好的区分能力。

Objective: To investigate the correlation of cancer-related fatigue and frailty with deep vein thrombosis(DVT) following peripherally inserted central catheter(PICC) placement in patients with gastric cancer. Methods: A total of 263 gastric cancer patients who underwent PICC placement at the 971st Hospital of the Chinese People's Liberation Army Navy between December 2020 and December 2025 were enrolled. Patients were divided into a non-DVT group(n=228) and a DVT group(n=35) based on the presence of DVT after PICC placement. General clinical data, frailty status and cancer-related fatigue were compared between the two groups. Multivariate Logistic regression analysis was performed to identify independent factors influencing DVT formation after PICC placement in gastric cancer patients. Stratified Logistic regression analysis was used to examine the correlation of frailty and cancer-related fatigue with post-PICC DVT. The predictive value of the established model was assessed using receiver operating characteristic(ROC) curves. Results: Multivariate Logistic regression analysis showed that tumor stage(≥Ⅲ), frailty, D-dimer(DD), neutrophil-to-lymphocyte ratio(NLR), serum albumin and Revised Piper Fatigue Scale(RPFS) score were independent influencing factors for DVT after PICC placement in gastric cancer patients(all P<0.05). After adding frailty and RPFS score to the model, the model fit improved significantly, and the overall prediction accuracy increased from 88.2% to 96.6%. ROC curve analysis revealed that the area under the curve(AUC) values for tumor stage, frailty, DD, NLR, serum albumin, RPFS score and the combined model for predicting DVT after PICC placement were 0.686, 0.765, 0.840, 0.801, 0.776, 0.738, and 0.946, respectively. At the optimal cut-off value, the combined model achieved a sensitivity and specificity of 0.857 and 0.947, respectively. Conclusion: Cancer-related fatigue and frailty status are independent risk factors for DVT formation following PICC placement in gastric cancer patients. The predictive model constructed based on these two factors preliminarily demonstrated good discriminatory ability.

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