机构地区:[1]重庆市第十三人民医院呼吸内科,重庆400053 [2]重庆巴南区中医院呼吸与危重医学科,重庆401320
出 处:《四川医学》2025年第4期374-379,共6页Sichuan Medical Journal
基 金:重庆巿卫生健康委医学科研项目(编号:2024WSJK120)。
摘 要:目的探究Padua评分联合血清25-羟基维生素D[25(OH)D]水平对无创呼吸机辅助通气治疗慢性阻塞性肺病急性加重期(AECOPD)患者发生静脉血栓栓塞症(VTE)的诊断价值。方法选取2024年1月至6月于我院和重庆市巴南区中医院住院予以无创呼吸机辅助通气治疗的AECOPD患者160例作为研究对象,根据是否发生VTE分为VTE组(n=71)和无VTE组(n=89)。所有患者均进行Padua评分;酶联免疫吸附(ELISA)法检测血清25(OH)D水平;多因素Logistic分析无创呼吸机辅助通气治疗AECOPD患者发生VTE的影响因素;运用ROC曲线分析Padua评分、25(OH)D水平及二者联合对无创呼吸机辅助通气治疗AECOPD患者发生VTE的诊断价值。结果VTE组患者血清25(OH)D水平显著低于无VTE组患者(P<0.05),VTE组患者Padua评分显著高于无VTE组患者(P<0.05);VTE组Padua评分高危患者比例明显多于无VTE组(P<0.05);多因素Logistic回归分析发现,25(OH)D、PaO 2是影响无创呼吸机辅助通气治疗AECOPD患者发生VTE的保护因素(P<0.05),D-D是影响无创呼吸机辅助通气治疗AECOPD患者发生VTE的危险因素(P<0.05);根据ROC曲线分析可知,血清25(OH)D水平单独对无创呼吸机辅助通气治疗AECOPD患者发生VTE诊断的AUC为0.852;Padua评分对无创呼吸机辅助通气治疗AECOPD患者发生VTE诊断的AUC为0.804,二者联合诊断时,AUC值为0.908,高于任一指标单独诊断(Z=1.451、2.434,P<0.05)。结论发生VTE的无创呼吸机辅助通气治疗AECOPD患者血清25(OH)D水平降低,Padua评分较高,Padua评分联合25(OH)D可有效诊断无创呼吸机辅助通气治疗AECOPD患者VTE发生。Objective To investigate the diagnostic value of the combination of Padua score and serum 25 hydroxyvitamin D[25(OH)D]level for venous thromboembolism(VTE)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)treated with non-invasive mechanical ventilation.Methods A total of 160 AECOPD patients who were hospitalized in our hospital from January to June 2024 and received non-invasive mechanical ventilation treatment were selected as the study subjects.They were separated into VTE group(n=71)and non VTE group(n=89)based on the occurrence of VTE.All patients underwent Padua scoring.Enzyme linked immunosorbent assay(ELISA)was applied to detect serum 25(OH)D level.Multivariate Logistic analysis was applied to analyze the influencing factors of VTE in AECOPD patients treated with non-invasive mechanical ventilation.ROC curve was applied to analyze the diagnostic value of Padua score,25(OH)D level,and their combination for the occurrence of VTE in AECOPD patients treated with non-invasive ventilation.Results The serum 25(OH)D level in the VTE group was obviously lower than that in the non VTE group(P<0.05),and the Padua score in the VTE group was obviously higher than that in the non VTE group(P<0.05).The proportion of patients with high-risk Padua score in the VTE group was obviously higher than that in the non VTE group(P<0.05).Multivariate Logistic regression analysis found that 25(OH)D and PaO 2 were protective factors for VTE in AECOPD patients treated with non-invasive mechanical ventilation(P<0.05),while D-D was a risk factor for VTE in AECOPD patients treated with non-invasive mechanical ventilation(P<0.05).According to the ROC curve,the AUC for diagnosing VTE in AECOPD patients treated with non-invasive ventilation alone with serum 25(OH)D level was 0.852.The Padua score had an AUC of 0.804 in the diagnosis of VTE in AECOPD patients treated with non-invasive mechanical ventilation.The combination of Padua score and 25(OH)D levels yielded an AUC of 0.908,which was significantly hig
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