西藏自治区人民医院住院患者静脉血栓栓塞症流行病学特征:基于高原地区慢病药学门诊视角的横断面研究

Epidemiological Characteristics of Venous Thromboembolism Among Inpatients at the People's Hospital of Xizang Autonomous Region: A Cross-Sectional Study from the Perspective of Chronic Disease Pharmaceutical Outpatient Services in a High-Altitude Region

  • 摘要: 目的 探究西藏自治区人民医院住院患者静脉血栓栓塞症(venous thromboembolism,VTE)的流行病学特征,为高原慢病药学门诊建立标准化风险筛查及药学监护体系提供数据支持。方法 本研究为回顾性横断面调查,选取2019年1月—2024年12月期间西藏自治区人民医院住院并诊断为VTE的患者。收集患者的一般资料、临床结局和抗凝治疗方案,采用Mann-Kendall趋势检验分析VTE患病率时间趋势,采用多因素Logistic回归分析VTE发生的影响因素。结果 共纳入939例VTE患者,其中女性492例(52.40%)、男性447例(47.60%),平均年龄为(54.87±20.10)岁。年龄≥65岁的老年患者339例,年龄<65岁的患者600例。治疗结局方面,临床改善(好转)率为79.02%,治愈率为10.76%。血栓类型方面,肺栓塞(pulmonary embolism,PE)占比最高(58.78%),其中低风险PE为主要亚型(35.5%)。VTE患者的合并症主要为高血压(39.94%),其次为急性心肌梗死或缺血性脑卒中(11.40%)。VTE患病率从2019年的0.62%升至2024年的1.07%,Mann-Kendall趋势检验显示,Kendall's Tau系数为0.733 (P=0.028),提示2019—2024年间该院VTE患者占比呈显著上升趋势。单因素Logistic回归分析显示,年龄≥65岁、高血压、超重/肥胖、糖尿病、肿瘤、心血管事件史、D-二聚体升高、估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)下降、高血红蛋白、住院科室与VTE的发生存在显著关联(P均<0.05)。多因素Logistic回归分析显示,在调整性别、民族、住院科室、D-二聚体、eGFR、肿瘤、糖尿病、心血管事件史、VTE病史及近期手术史后,高血压(aOR=2.30,95%CI:1.80~2.94,P<0.001)、超重/肥胖(aOR=1.78,95%CI:1.34~2.36,P<0.001)及年龄≥65岁(aOR=1.28,95%CI:1.01~1.62,P=0.041)与VTE呈显著正相关,高血红蛋白与VTE呈显著负相关(aOR=0.75,95%CI:0.59~0.95,P=0.018)。亚组分析显示,内科患者中,高血压(aOR=2.51,95%CI:1.89~3.33,P<0.001)及超重/肥胖(aOR=1.92,95%CI:1.40~2.63,P<0.001)与VTE均呈显著正相关;而在外科患者中,仅高血压与VTE呈显著正相关(aOR=1.92,95%CI:1.20~3.07,P=0.007)。年龄分层结果显示,<65岁患者中,超重/肥胖与VTE呈显著正相关(aOR=2.05,95%CI:1.48~2.84,P<0.001);而≥65岁患者中,超重/肥胖与VTE未见显著关联(aOR=1.41,95%CI:0.94~2.12,P=0.098)。出院抗凝以利伐沙班单药为主(43.56%),33.33%的患者出院未带抗凝药。结论 西藏自治区人民医院VTE患病率呈上升趋势,重点风险人群为伴高血压、肥胖的慢病患者,需进一步加强VTE早期识别、合并症管理及慢病患者用药监护,以提升高原地区VTE的综合管理效果。

     

    Abstract: Objective To investigate the epidemiological characteristics of venous thromboembolism (VTE) among inpatients at the People's Hospital of Tibet Autonomous Region,and to provide data support for the establishment of a standardized risk screening and pharmaceutical care system in the plateau chronic disease pharmaceutical clinic. Methods This study was a retrospective cross-sectional survey. Patients discharged with a diagnosis of VTE from the People's Hospital of Tibet Autonomous Region between January 2019 and December 2024 were selected. General data,clinical outcomes,and anticoagulation regimens were collected. The Mann-Kendall trend test was used to analyze the temporal trend of VTE prevalence,and multivariate Logistic regression was used to analyze the influencing factors of VTE occurrence. Results A total of 939 VTE patients were included,comprising 492 females (52.40%) and 447 males (47.60%),with a mean age of (54.87± 20.10) years. There were 339 elderly patients aged ≥ 65 years and 600 patients aged <65 years. In terms of treatment outcomes,the clinical improvement (improvement) rate was 79.02%,and the cure rate was 10.76%. Among thrombus types,pulmonary embolism (PE) accounted for the highest proportion (58.78%),with low-risk PE being the main subtype (35.5%). The main comorbidity among VTE patients was hypertension (39.94%),followed by acute myocardial infarction or ischemic stroke (11.40%). The prevalence of VTE increased from 0.62% in 2019 to 1.07% in 2024. The Mann-Kendall trend test showed a Kendall's Tau coefficient of 0.733 (P=0.028),indicating a significant upward trend in the proportion of VTE patients at the hospital from 2019 to 2024. Univariate Logistic regression analysis showed that age ≥ 65 years,hypertension,overweight/obesity,diabetes,tumor,history of cardiovascular events,elevated D-dimer,decreased estimated glomerular filtration rate (eGFR),high hemoglobin,and inpatient department were significantly associated with the occurrence of VTE (all P<0.05). Multivariate Logistic regression analysis showed that after adjusting for sex,ethnicity,inpatient department,D-dimer,eGFR,tumor,diabetes,history of cardiovascular events,history of VTE,and recent surgical history,hypertension (aOR=2.30,95% CI:1.80-2.94,P<0.001),overweight/obesity (aOR=1.78,95% CI:1.34-2.36,P<0.001),and age ≥ 65 years (aOR=1.28,95% CI:1.01-1.62,P=0.041) were significantly positively correlated with VTE,while high hemoglobin was significantly negatively correlated with VTE (aOR=0.75,95% CI:0.59-0.95,P=0.018). Subgroup analysis showed that among internal medicine patients,hypertension (aOR=2.51,95% CI:1.89-3.33,P<0.001) and overweight/obesity (aOR=1.92,95% CI:1.40-2.63,P<0.001) were significantly positively correlated with VTE; while among surgical patients,only hypertension was significantly positively correlated with VTE (aOR=1.92,95% CI:1.20-3.07,P=0.007). Age stratification results showed that among patients aged <65 years,overweight/obesity was significantly positively correlated with VTE (aOR=2.05,95% CI:1.48-2.84,P<0.001); while among patients aged ≥ 65 years,overweight/obesity was not significantly associated with VTE (aOR=1.41,95% CI:0.94-2.12,P=0.098). Discharge anticoagulation was mainly rivaroxaban monotherapy (43.56%),and 33.33% of patients were discharged without anticoagulant medication. Conclusions The prevalence of VTE at the People's Hospital of Tibet Autonomous Region is on the rise. The key risk population consists of chronic disease patients with hypertension and obesity. It is necessary to further strengthen early identification of VTE,management of comorbidities,and medication monitoring for chronic disease patients,so as to improve the comprehensive management of VTE in plateau areas.

     

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