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Padua风险评估模型对内科住院患者静脉血栓栓塞症的评估价值

王欣 洪新宇 李金玉 赵瑞杰 杨煜清 柳思华 孙雪峰 朱卫国 范俊平 施举红

王欣, 洪新宇, 李金玉, 赵瑞杰, 杨煜清, 柳思华, 孙雪峰, 朱卫国, 范俊平, 施举红. Padua风险评估模型对内科住院患者静脉血栓栓塞症的评估价值[J]. 协和医学杂志, 2018, 9(3): 234-241. doi: 10.3969/j.issn.1674-9081.2018.03.009
引用本文: 王欣, 洪新宇, 李金玉, 赵瑞杰, 杨煜清, 柳思华, 孙雪峰, 朱卫国, 范俊平, 施举红. Padua风险评估模型对内科住院患者静脉血栓栓塞症的评估价值[J]. 协和医学杂志, 2018, 9(3): 234-241. doi: 10.3969/j.issn.1674-9081.2018.03.009
Xin WANG, Xin-yu HONG, Jin-yu LI, Rui-jie ZHAO, Yu-qing YANG, Si-hua LIU, Xue-feng SUN, Wei-guo ZHU, Jun-ping FAN, Ju-hong SHI. Value of Padua Risk Assessment Model in Evaluating Venous Thromboembolism of Hospitalized Patients in the Department of Internal Medicine[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(3): 234-241. doi: 10.3969/j.issn.1674-9081.2018.03.009
Citation: Xin WANG, Xin-yu HONG, Jin-yu LI, Rui-jie ZHAO, Yu-qing YANG, Si-hua LIU, Xue-feng SUN, Wei-guo ZHU, Jun-ping FAN, Ju-hong SHI. Value of Padua Risk Assessment Model in Evaluating Venous Thromboembolism of Hospitalized Patients in the Department of Internal Medicine[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(3): 234-241. doi: 10.3969/j.issn.1674-9081.2018.03.009

Padua风险评估模型对内科住院患者静脉血栓栓塞症的评估价值

doi: 10.3969/j.issn.1674-9081.2018.03.009
基金项目: 

国家"十三五"精准医学研究 2016YF0905603

详细信息
    通讯作者:

    施举红 电话:010-69155028, E-mail:shijh@pumch.cn

  • 中图分类号: R654.3

Value of Padua Risk Assessment Model in Evaluating Venous Thromboembolism of Hospitalized Patients in the Department of Internal Medicine

More Information
    Corresponding author: SHI Ju-hong Tel: 010-69155028, E-mail: shijh@pumch.cn
  • 摘要:   目的  调查内科住院患者静脉血栓栓塞症(venous thromboembolism, VTE)现状, 探究Padua风险评估模型是否适用于内科住院患者。   方法  回顾分析2016年5月17日至9月9日北京协和医院内科住院患者基本信息和VTE危险因素、预防措施及发生情况, 比较住院期间及出院后3个月内发生与未发生VTE患者的异同点, 评估危险因素与VTE事件相关性。使用Padua风险评估模型对患者进行VTE风险分层并采用Logistic回归分析评估其预测价值。   结果  共3115例患者纳入本研究, 症状性VTE发生率为2.5%。Padua模型敏感度为83.3%, 特异度为62.3%, 模型分层下高危患者占比38.8%。Padua模型中高龄、急性心肌梗死/缺血性卒中、肥胖、近期创伤和(或)手术这4项危险因素在VTE及非VTE患者间无统计学差别(P>0.05), 而模型未包含的危险因素如雌、孕激素、输血、机械通气与VTE发生显著相关(P均 < 0.01)。Padua模型高危患者接受抗凝药物预防及机械预防的比例显著高于低危患者(P < 0.01), 其中85.3%的高危患者未接受抗凝药物或机械预防, 亦未发生VTE。   结论   Padua模型特异度低, 模型中多项危险因素及其权重分布不合理, 对内科住院患者VTE风险分层的价值有限。
  • 图  1  内科住院患者Padua风险评估模型风险分层受试者特征曲线

    图  2  Padua风险评估模型分层后各科室患者VTE的风险、预防及事件分布

    VTE:同表 1; ICU:重症监护病房

    表  1  内科住院患者Padua风险评估模型分组比较

    一般情况 高危组 低危组 P
    例数(n) 1209 1906 -
    男性[n(%)] 692(57) 1031(54) >0.05
    年龄(x±s, 岁) 55 ±17 52±16 <0.01
    BMI(x±s, kg/m2) 23.3±4.1 23.6±4.3 >0.05
    住院时间[M(Q), d] 11(6~19) 18(9~29) <0.01
    VTE事件[n(%)]
      DVT 43(3.6) 8(0.4) <0.01
      PTE 12(1.0) 4(0.2) <0.05
      DVT合并PTE 10(0.8) 1(0.05) <0.01
    BMI:体质量指数; VTE:静脉血栓栓塞症; DVT:深静脉血栓形成; PTE:肺血栓栓塞症
    下载: 导出CSV

    表  2  Padua风险评估模型危险因素与内科住院患者VTE相关性

    模型中危险因素 VTE组[n(%)] 非VTE组[n(%)] OR值(95%置信区间) P
    例数(n) 78 3037 - -
    活动性恶性肿瘤/化疗 35(44.8) 871(28.7) 2.0(1.3, 3.2) <0.01
    既往VTE 28(35.9) 22(0.7) 76.7(41.1, 143.3) <0.01
    活动减少 43(55.1) 1068(35.2) 2.3(1.4, 3.6) <0.01
    已有血栓形成倾向 12(15.4) 56(1.9) 9.7(5.0, 19.0) <0.01
    近期创伤/手术史 1(1.3) 108(3.6) 0.4(0.1, 2.6) >0.05
    高龄(年龄≥70岁) 16(20.5) 435(14.3) 1.5(0.9, 2.7) >0.05
    心脏/呼吸衰竭 13(16.7) 125(4.1) 4.7(2.5, 8.7) <0.01
    急性心肌梗死/缺血性卒中 1(1.3) 46(1.6) 0.8(0.1, 6.2) >0.05
    急性感染/风湿性疾病 37(47.4) 753(24.8) 2.7(1.7, 4.3) <0.01
    肥胖(BMI≥30 kg/m2) 2(2.6) 170(5.6) 0.4(0.1, 1.8) >0.05
    使用激素治疗 41(52.6) 1036(34.1) 2.1(1.4, 3.4) <0.01
    VTE、BMI:同表 1
    下载: 导出CSV

    表  3  Padua风险评估模型未包含的危险因素与VTE相关性[n(%)]

    危险因素 VTE组[n(%)] 非VTE组[n(%)] OR值(95%置信区间) P
    例数(n) 78 3037 - -
    男性 31(39.7) 1361(44.8) 0.8(0.5, 1.3) >0.05
    使用雌孕激素 3(3.9) 20(0.7) 6.0(1.8, 20.8) <0.01
    VTE家族史 0(0) 1(0.03) >0.05
    高血压 31(39.7) 1029(33.9) 1.3(0.8, 2.0) >0.05
    冠状动脉粥样硬化性心脏病 4(5.1) 381(12.6) 0.4(0.1, 1.0) >0.05
    糖尿病 14(18.0) 586(19.3) 0.9(0.5, 1.6) >0.05
    吸烟 26(33.3) 1081(35.6) 0.9(0.6, 1.5) >0.05
    输血 14(18.0) 145(4.8) 4.4(2.4, 8.0) <0.01
    机械通气 7(9.0) 77(2.5) 3.8(1.7, 8.5) <0.01
    VTE:同表 1
    下载: 导出CSV

    表  4  Padua风险评估模型与VTE预防[n(%)]

    VTE预防措施 高危组(n=1209) 低危组(n=1906) P
    阿司匹林预防 255(21.1) 413(21.7) >0.05
    抗凝药物预防 105(8.7) 28(1.5) <0.01
    机械预防 64(5.3) 38(2.0) <0.01
    抗凝药物或机械预防 148(12.2) 61(3.2) <0.01
    任意形式预防 292(24.2) 435(22.8) >0.05
    VTE:同表 1
    下载: 导出CSV
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  • 收稿日期:  2018-01-03
  • 刊出日期:  2018-05-30

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