肿瘤内科住院患者静脉血栓栓塞症危险因素及2种风险评估模型预测价值研究

Risk factors of venous thromboembolism and the predictive value of two risk assessment models in medical oncology inpatients

目的探讨肿瘤内科住院患者静脉血栓栓塞症(VTE)的危险因素,分析Khorana和Padua风险评估模型对VTE的预测能力。方法收集2019-01-01-2019-08-31新乡市中心医院肿瘤内科收治47例恶性肿瘤合并VTE患者的临床资料,设置为血栓组,另外选取同期住院未发生VTE的恶性肿瘤患者101例,设置为对照组。收集相关资料,分析2组患者组间差异,探讨VTE发生的危险因素;使用Khorana、Padua风险评估模型进行VTE风险评估,探究其预测VTE的能力。结果单因素分析结果显示,吸烟史(OR=0.298,P=0.028)、D-二聚体升高(OR=2.150,P<0.001)、Padua评分≥5分(OR=3.120,P=0.013)、血红蛋白<100 g/L(OR=2.688,P=0.016)与肿瘤内科住院患者VTE风险具有相关性;二分类结果显示,D-二聚体升高是VTE的独立危险因素,OR=1.214,P=0.001;2组患者Khorana和Padua评分差异无统计学意义,Khorana和Padua风险评估模型评估VTE的ROC曲线下面积差异无统计学意义,均P>0.05;D-二聚体评估VTE的ROC曲线下面积差异有统计学意义(P<0.001),D-二聚体的约登指数最大值为0.452,对应的D-二聚体数值为2.16 mg/L(正常上限的3.93倍),对应的灵敏度为0.660,特异度为0.792。结论对于肿瘤内科住院患者,Padua和Khorana风险评估模型对VTE的预测能力差;D-二聚体升高是VTE发生的独立危险因素,对VTE的预测能力良好。

Objective To investigate the risk factors of venous thromboembolism(VTE)in medical oncology inpatients and the predictive value of Khorana and Padua risk assessment models.Methods The clinical data of 47 patients with malignant tumor and VTE admitted to the Department of Medical Oncology of Xinxiang Central Hospital from January 1 to August 31,2019 were collected and set as the thrombus group.In addition,101 patients with malignant tumor but without VTE were selected and set as the control group.Collected relevant data,analyzed the differences between the two groups of patients,and explored the risk factors of VTE.Khorana and Padua risk assessment models were used to conduct VTE risk assessment and explore their ability to predict VTE.Results Univariate analysis showed that smoking history(OR=0.298,P=0.028),increased D-dimer(OR=2.150,P<0.001),Padua score≥5(OR=3.120,P=0.013)and hemoglobin<100 g/L(OR=2.688,P=0.016)were associated with risk of VTE.Dichotomies showed that elevated D-dimer as an independent risk factor for VTE,OR=1.214,P=0.001.Khorana and Padua scores showed no difference between the two groups,and the area under ROC curve assessed by Khorana and Padua risk assessment models had no statistical significance(all P>0.05).The area under ROC curve for D-dimer evaluation of VTE was statistically significant(P<0.001).The maximum value of The Yoden index of D-dimer was 0.452,corresponding value of D-dimer was 2.16 mg/L(3.93 times of the upper normal limit),corresponding sensitivity was 0.660,and corresponding specificity was 0.792.Conclusions The Padua and Khorana risk assessment models can not accurately reflect the risk of VTE in medical oncology inpatients.Elevated D-dimer is an independent risk factor for VTE,and it has good predictive ability for VTE.