Caprini风险评估模型筛选内科住院患者静脉血栓栓塞症的有效性  

Validity of Caprini risk assessment model in identifying high venous thromboembolism risk patientsamong hospitalized medical patients

作　　者：周海霞[1] 唐永江[1] 王岚[1] 肖军[2] 王博[1] 杨婧[1] 罗达[3] 李娟[3] 陈晓雷[3] 冯玉麟[1] 易群[1] 

机构地区：[1]四川大学华西医院呼吸内科,成都610041 [2]四川大学华西医院ICU,成都610041 [3]四川大学华西医院医学技术专业,成都610041

出　　处：《中华医学杂志》2013年第24期1864-1867,共4页National Medical Journal of China

基　　金：国家“十一五”科技攻关课题（2006BAl01A06）

摘　　要：目的验证Caprini风险评估模型在内科住院患者中筛选静脉血栓栓塞症（VTE）的有效性。方法采用病例对照研究，以2010年1月至2011年12月四川大学华西医院内科住院患者中确诊的218例VTE患者作为VTE组，以随机数字表法随机选取同时期同科室的无VTE的394例住院患者作为对照组，依据Caprini风险评估模型对两组患者进行回顾性评分和VTE危险分级。比较两组得分情况并探讨分级与VTE发生风险的关系。结果Caprini风险评估模型评估结果：vTE组平均评分为（4．9±2．6）分，显著高于对照组的（3．2±2．0）分（P=0．000）；中危患者与低危患者发生VTE的风险差异无统计学意义（OR=1．26，95％CI为0．62—2．56）；高危患者发生VTE的风险是低危患者的2．00倍（95％CI为1．10—3．61），极高危患者发生VTE的风险是低危患者的5．76倍（95％CI为3．24—10．24），差异均有统计学意义（均P〈0．05）。进一步分析评级为极高危的患者后发现，得分5～6分的极高危患者发生VTE的风险是低危患者的4．15倍（95％CI为2．28～7．56），得分7—8分的极高危患者发生VTE的风险是低危患者的11．13倍（95％CI为4．88—25．36），而I〉9分的极高危患者发生VTE的风险为低危患者的21．00倍（95％CI为6．34—69．52）。结论Caprini风险评估模型可有效地基于个体危险因素对内科住院患者进行量化的VTE风险评估。Objective To test the validity of Caprini risk assessment model in identifying high venous thromboembolism （VTE） risk patients among hospitalized medical patients. Methods A retrospective case-control study was performed among hospitalized medical patients admitted into West China Hospital, Sichuan University from January 2010 and December 2011. A total of 218 patients with definite VTE during hospitalization were recruited. And 394 controls were randomly selected from the patients without VTE admitted into the same departments within the same period. The risks of both cases and controls were retrospectively assessed with the Caprini risk assessment model. Results The average Caprini cumulative risk score in cases was significant higher than that in controls （4. 9 ＋2. 6 vs 3.2 ＋2. 0, P =0. 000）. There was no significant difference in the risk of VTE between the patients at a low risk by Caprini model and those at a moderate risk （OR = 1.26, 95% CI： O. 62 -2. 56）. Compared with a low risk, those with a high risk were associated with 2. O0-fold increased risk of VTE （95% CI： 1.10 - 3.61 ）, a highest risk was associated with 5.76-fold increased risk of VTE （95% CI： 3.24 - 10. 24） （both P 〈 0. 05 ）. When further stratifying the highest risk level with cumulative risk score I〉5 into 5 -6, 7 -8, and ≥9 risk level, the patients with score 5 -6 were associated with 4. 15-fold increased risk of VTE （95% CI： 2. 28 -7.56）, those with score 7- 8 11.13-fold increased risk of VTE （95% CI： 4. 88 -25.36） and those with score I〉 9 21.00-fold increased risk of VTE （95 % CI： 6. 34 -69.52） compared with low risk counterparts. Conclusion Caprini risk assessment model can effectively and quantitatively assess the risk of VTE among hospitalized medicalpatients based on their individual VTE risk factors.

关 键 词：血栓栓塞 危险性评估 住院病人 病例对照研究 

分 类 号：R54[医药卫生—心血管疾病]