凝血指标D-Dimer联合Khorana评分模型预测肿瘤患者化疗后静脉血栓风险的价值

Value of coagulation index D-Dimer combined with Khorana scoring model in predicting the risk of venous thrombosis in tumor patients after chemotherapy

目的:探讨凝血指标联合Khorana评分模型预测肿瘤患者化疗后静脉血栓风险的价值。方法:选取2019年01月至2022年09月某三级甲等医院收治确诊恶性肿瘤并接受化学治疗的患者100例,包括60例静脉血栓栓塞(venous thromboembolism, VTE)患者为试验组,40例无VTE的患者为对照组;采用彩色多普勒超声检查或肺动脉造影检查确诊VTE,比较两组患者一般资料及凝血指标[D-二聚体(D-Dimer)、纤维蛋白原(fibrinogen, Fib)],通过绘制受试者工作特征曲线(receiver operating characteristic curve, ROC)评价凝血指标联合Khorana评分对肿瘤患者静脉血栓风险预测的灵敏度及特异度。结果:两组患者D-Dimer及Fib水平具有统计学差异(P<0.05),试验组D-Dimer及Fib水平均明显高于对照组;D-Dimer对静脉血栓风险的预测价值高于Fib, D-Dimer最佳截断值为2.28 mg/L;将D-Dimer纳入Khorana模型中的评估项,赋分1~3分,其中赋予2分后,新评估模型静脉血栓风险的预测的特异度及灵敏度与Khorana模型相比均有较大的提升,AUC为0.901,约登指数为0.658,灵敏度为0.733,特异度为0.925。结论:凝血指标D-Dimer对于提高Khorana评分模型对肿瘤患者化疗后血栓发生风险的预测有着重要价值。

Objective:To investigate the value of coagulation index combined with Khorana score in predicting the risk of venous thrombosis in tumor patients receiving chemotherapy.Methods:A total of 100 patients with malignant tumors diagnosed and treated with chemotherapy were selected in a GradeⅢGrade A hospital from January 2019 to September 2022.Sixty patients with VTE were selected as the test group,and forty patients without VTE were selected as the control group.VTE was diagnosed by color Doppler ultrasound or pulmonary angiography.General data and coagulation indexes(D-Dimer and fibrinogen)were compared between the two groups.The sensitivity and specificity of coagulation index combined with Khorana score in predicting the risk of venous thrombosis in tumor patients were evaluated by drawing ROC curve.Results:The D-Dimer and fibrinogen in the two groups were statistically different(P<0.05).The D-Dimer and fibrinogen in the test group were significantly higher than those in the control group.The predictive value of D-Dimer for thrombosis was higher than that of fibrinogen.The optimal cutoff value of D-Dimer was 2.28 mg/L.The D-Dimer was included in the evaluation item of Khorana model,and 1~3 points were assigned.In the evaluation model with assigning 2 points,the specificity and sensitivity of thrombus prediction of the new evaluation model were significantly improved compared with that of Khorana model,with AUC of 0.901,Youden index of 0.658,sensitivity of 0.733,and specificity of 0.925.Conclusion:As a coagulation index,D-Dimer is of great significance in improving the thrombosis prediction of Khorana model for tumor patients receiving chemotherapy.