3种风险评估量表预测肿瘤住院患者静脉血栓栓塞症发生的应用研究  

Application research on three risk assessment tools predicted the venous thromboembolism inpatients with malignant tumor

作　　者：覃芹丹 王春秀[1] 李芬[1] 谢雅琴 QIN Qindan;WANG Chunxiu;LI Fen;XIE Yaqin(The First People′s Hospital of Tianmen City,Tianmen 431700,China)

机构地区：[1]天门市第一人民医院

出　　处：《西北国防医学杂志》2019年第11期712-717,共6页Medical Journal of National Defending Forces in Northwest China

基　　金：湖北省卫生计生委科研项目(WJ2019H213)

摘　　要：目的:探讨Caprini风险评估量表、Padua风险评估量表和Khorana风险评估量表对肿瘤住院患者静脉血栓栓塞症(venous thromboembolism,VTE)发生的预测价值。方法:选取2018-01~12在湖北省天门市某三级甲等医院住院期间诊断为VTE的肿瘤患者141例,另选同期非VTE的肿瘤住院患者282例为对照组,其中5例因不符合纳入及排除标准被剔除,最终纳入277例。分析两组的Caprini评分、Padua评分和Khorana评分与VTE发生风险的关系。结果:两组的年龄、性别、Khorana评分比较差异无统计学意义(P>0.05);Caprini评分、Padua评分比较差异有统计学意义(P<0.01);Caprini评分、Padua评分、Khorana评分的ROC曲线下面积(area under the curve,AUC)依次为0.789、0.660、0.536,Caprini量表的AUC显著大于Padua量表和Khorana量表,差异有统计学意义(P<0.05)。通过ROC曲线选取Caprini风险评估量表约登指数最大值7分为最佳截断值。随着Caprini分级增加,VTE发生风险逐渐增加,高危者发生VTE风险是中危者的4.35倍,在高危患者亚组中,评分为5分和6分的患者与中危者相比,差异无统计学意义(P>0.05);而7分及以上的患者随评分增高发生VTE的风险明显增高,差异有统计学意义(P<0.01)。结论:Caprini量表评分对肿瘤住院患者VTE发生风险的预测准确性优于Padua评分和Khorana评分,重新确立Caprini危险级别标准,以7分为截断值,可提高Caprini量表对肿瘤住院患者VTE发生的预测准确性。Objective:To investigate the predictive value of three risk assessment tools on venous thromboembolism(VTE)with inpatients with malignant tumor.Methods:A total of 141 VTE patients with malignant tumor diagnosed in Tianmen first people′s hospital between January 2018 and December 2018 as VTE group,and 282 non-VTE patients admitted into the same departments during the same time period as control group,5 patients were excluded because they didn′t meet the inclusion and exclusion criteria,277 cases were eventually included.Caprini risk assessment tool,Padua risk assessment tool and Khorana risk assessment tool between the two groups were analyzed.Results:There were no obvious differences of age,gender and Khorana score between the two groups(P>0.05).And there were statistically significant differences of Caprini score and Padua score(P<0.05).ROC curve showed that,the area under the curve(AUC)of Caprini score,Padua score and Khorana score in predicting VTE in patients with malignant tumor was 0.789,0.660 and 0.536,respectively.Caprini score was significantly greater than Padua score and Khorana score,the difference was statistically significant(P>0.01).Through the ROC curve,when the Caprini score was 7 points,which the yoden index is the largest,it is the best cut-off value.The risk of VTE increased with the increase of Caprini risk 1evels,compared with Caprini moderate risk,classification of high risk was associated with 4.35-fold increased risk of VTE,within the high subgroup,patients with a score of 5 and 6 points had no statistically significant difference compared with the moderate risk,patients with 7 or more points had a significant higher risk of VTE as the score increases.Conclusion:The predictive value of Caprini score for VTE in patients with malignant tumor is better than Padua score and Khorana score,reestablishing the Caprini grading standard,with a cutoff value of 7 points to improve the predictive accuracy of the Caprini scale for VTE inpatients with malignant tumor.

关 键 词：静脉血栓栓塞症 恶性肿瘤 风险评估 Caprini量表 

分 类 号：R73[医药卫生—肿瘤]