Caprini血栓风险评分联合纤维蛋白相关标志物对静脉血栓栓塞症诊断价值的多中心临床研究

Multicentre clinical study of the value of the Caprini thrombosis risk score combined with fibrin-related markers for the diagnosis of venous thromboembolism

目的基于多中心数据探究Caprini血栓风险评分(Caprini评分)联合纤维蛋白相关标志物对静脉血栓栓塞症(VTE)的诊断价值。方法选取2020年1月至2023年1月收治的309例疑似VTE住院患者,依据有无发生VTE分为VTE组和非VTE组,比较2组患者Caprini评分、纤维蛋白相关标志物[纤维蛋白单体(FM)、纤维蛋白/纤维蛋白原降解产物(FDP)、D-二聚体(D-dimer,DDI)]及基线资料。采用二元Logistic回归模型明确VTE的危险因素,并采用受试者工作特征(ROC)曲线对各指标诊断VTE的效能进行分析。结果与非VTE组比较,VTE组患者Caprini评分、FM、FDP及DDI水平均升高(P<0.05)。与非VTE组比较,VTE组患者合并高血压、肺动脉高压、使用激素治疗患者占比较低(P<0.05),合并恶性肿瘤患者占比、血小板计数、肌酐、PT、APTT、FIB水平较高(P<0.05)。二元Logistic回归分析结果显示,Caprini评分、FM、FDP和DDI升高是影响VTE的独立危险因素(P<0.05)。依据Logistic回归分析结果构建VTE联合预测模型方程Logit(P)=-0.291+1.547×Caprini评分+0.414×FM+0.522×FDP+1.035×DDI(χ^(2)=20.229,P<0.001),将309例住院患者数据代入模型方程,依据是否发生VTE绘制ROC曲线,结果显示联合预测模型预测VTE的AUC为0.891(0.857~0.935),灵敏度为95.35%,特异度为75.94%,联合预测模型的AUC高于Caprini评分、FM、FDP、DDI单独应用的诊断价值。结论住院VTE患者维蛋白相关标志物FM、FDP及DDI异常升高,基于Caprini评分、FM、FDP及DDI构建的联合预测模型有助于临床诊断VTE。

Objective To investigate the diagnostic value of the Caprini Thrombosis Risk Score(Caprini score)combined with fibrin-related markers for venous thromboembolism(VTE)based on multicentre data.Methods 309 hospitalized patients with suspected VTE admitted from January 2020 to January 2023 were selected and divided into VTE and non-VTE groups based on the presence or absence of VTE.Caprini scores,fibrin-related markers[fibrin monomer(FM),fibrin/fibrinogen degradation products(FDP),D-dimer(DDI)]and baseline information were compared between the two groups.A binary logistic regression model was used to identify risk factors for VTE and the efficacy of each indicator in diagnosing VTE was analysed using subject operating characteristic(ROC)curves.Results Caprini score,FM,FDP and DDI levels were higher in the VTE group compared to the non-VTE group(P<0.05).Compared with the non-VTE group,the VTE group had a lower proportion of patients with hypertension,pulmonary hypertension and hormone therapy,and a higher proportion of patients with combined malignancy,platelet count,creatinine,PT,APTT and FIB levels(P<0.05).Binary logistic regression analysis showed that elevated Caprini score,FM,FDP and DDI were independent risk factors for VTE(P<0.05).Based on the results of logistic regression analysis,the joint prediction model equation for VTE was constructed Logit(P)=-0.291+1.547×Caprini score+0.414×FM+0.522×FDP+1.035×DDI(χ^(2)=20.229,P<0.001).The data of 309 inpatients were substituted into the model equation,and the ROC curve was plotted based on whether VTE occurred or not,and the results showed that the AUC of the combined prediction model for predicting VTE was 0.891(0.857~0.935),with a sensitivity of 95.35%and a specificity of 75.94%,and the AUC of the combined prediction model was higher than that of the Caprini score,FM,FDP,and DDI applied alone the diagnostic value.Conclusion Vimentin-related markers FM,FDP and DDI were abnormally elevated in hospitalised VTE patients,and a joint prediction model constructed on the basis of Caprini score,FM,FDP and DDI helped in the clinical diagnosis of VTE.