肿瘤内科住院患者静脉血栓危险因素分析及现有风险评估模型预测价值研究  

Risk factors of venous thromboembolism and evaluation of existing risk assessment models for predicting venous thromboembolism in medical oncology inpatients

作　　者：门学千 李贺明[2] 董茜 王远鹤 周进 李艳荣 张敬东 MEN Xue-qian;LI He-ming;DONG Qian;WANG Yuan-He;ZHOU Jin;LI Yan-rong;ZHANG Jing-dong(Department of Medical Oncology,Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, China)

机构地区：[1]中国医科大学肿瘤医院,辽宁省肿瘤医院肿瘤内科,辽宁沈阳110042 [2]大连大学附属中山医院肿瘤科,辽宁大连116001

出　　处：《中国实用内科杂志》2019年第8期694-697,共4页Chinese Journal of Practical Internal Medicine

基　　金：国家重点研发项目(2018YFC1311603);辽宁省科技厅资助课题(201800449);沈阳市科学技术计划项目(F15-139-9-27);辽宁省肿瘤医院人才引进科研基金(Z1702))

摘　　要：目的探讨肿瘤内科住院患者发生静脉血栓栓塞症(VTE)的风险因素及现有风险评估模型的预测能力。方法纳入2017年7月至2019年3月辽宁省肿瘤医院肿瘤内科住院的252例患者,按是否发生VTE分为研究组63例及对照组189例。应用霍拉纳评分(KRS)及帕多瓦预测评分(PPS)评估VTE风险,通过Logistic回归分析,探究发生VTE的危险因素并评估KRS及PPS的预测能力。结果 VTE病史、卧床≥3 d、血小板数目≥350×10^9/L、D-二聚体>0.55 mg/L、Ⅳ期肿瘤共5项风险因素与增加VTE风险相关(OR分别为12.149、3.672、3.144、5.263、1.439、1.382,均P<0.05)。通过KRS进行风险评估,低、中危风险组中,研究组及对照组的差异有统计学意义(均P<0.01),而高危组差异无统计学意义。通过PPS进行风险评估,低、高危风险组中差异均无统计学意义。结论在肿瘤内科住院患者中,VTE病史、卧床≥3 d、血小板数目≥350×10^9/L、D-二聚体>0.55 mg/L、Ⅳ期肿瘤为发生VTE的独立风险因素。KRS在低中危人群中能够很好预测血栓风险,而PPS预测能力有限。Objective To investigate the risk factors of venous thrombosis(VTE) and to evaluate the predictive ability of the existing risk assessment models(RAM) in medical oncology inpatients. Methods In this study, 252 medical oncology inpatients were divided into study group(63) and control group(189) according to VTE. Logistic regression analysis was performed to identify the risk factors of VTE and to evaluate the predictive ability of KRS and PPS. Results This study showed that previous VTE, staying in bed≥3 d,platelet count≥350×10^9/L, D-dimer>0.55 mg/L and stage IV cancer were associated with VTE risks(OR=12.149, 3.672, 3.144, 5.263,1.439, 1.382, P<0.05). Furthermore, we performed the risk assessment of VTE according to KRS and PPS respectively. For KRS, in the low-and intermediate-risk subgroup, statistical difference existed between study and control group(P<0.01);but in high-risk subgroup,no significant difference existed between study and control group. For PPS, no significant difference existed between study and control group. Conclusion For the inpatients of medical oncology department, previous VTE, staying in bed≥3 d, platelet count≥350×10^9/L, D-dimer>0.55 mg/L, and stage IV cancer are independent risk factors of VTE. Compared with the limited predictive ability of PPS,KRS can predict VTE very well for low-and intermediate-risk patients.

关 键 词：恶性肿瘤 静脉血栓 危险因素 风险评估模型 

分 类 号：R73[医药卫生—肿瘤]