两种风险评估模型在孕产妇下肢深静脉血栓形成中预测价值的比较

Comparison of the predictive performance of different risk assessment model in patients with deep vein thrombosis during pregnancy and postpartum

目的:评价和比较不同风险评估模型在孕产妇下肢深静脉血栓形成(DVT)中的预测价值,探讨适合我国南方地区孕产妇人群的血栓风险评估模型。方法:回顾调查2003年1月至2013年10月南方医科大学南方医院和广州医科大学附属第三医院共304例孕产妇的病历资料,其中DVT组144例,对照组160例,分别采用Wells Score模型和RCOG模型对纳入的孕产妇进行血栓风险分层验证。应用非参数检验和ROC曲线分析评价两种模型的预测价值。结果:(1)DVT组144例中,138例(95.8%)发生单纯DVT,DVT合并肺栓塞(PE)患者6例(4.2%);发生左下肢DVT者108例(75.0%),右下肢DVT者34例(23.6%),双下肢DVT者2例(1.4%)。(2)根据Wilcoxon检验,两种模型在DVT组和对照组患者风险等级识别上均有显著差异(P<0.05),平均秩次值显示,Wells Score模型能将更多的DVT患者划分到更高的风险等级,并把更多的非DVT患者分类到低危风险级别。Wells Score模型均具有较高的灵敏度(0.99)和特异度(0.86),并具有最大的阳性似然比(7.22)和最小的阴性似然比(0.01)。(3)Wells Score模型预测DVT风险的ROC曲线下面积为0.955±0.011,RCOG模型为0.696±0.030;两模型比较无显著差异(P=0.899)。结论:两种风险评估模型对孕产妇下肢DVT均具有较准确的预测能力,其中Wells Score模型的预测价值最高,使用方便,能帮助妇产科医师识别潜在的DVT风险孕产妇并指导其血栓预防决策。

Objective：To validate and compare the predictive performance of different risk assessment models in patients with deep vein thrombosis （ DVT ） during pregnancy and postpartum. Methods：Data from 304 peripartum women in Nanfang hospital of Southern Medical University and Third Affiliated Hospital of Guangzhou Medical University from 2003 Jan. to 2013 Oct. were analyzed retrospectively. Patients were risk-stratified using two different risk assessment models and the predictive capacities of these model were compared. Results：（ 1 ） Of the DVT group,138 cases （75. 0%） had DVT only,34 （23. 6%） had both DVT and PE. Among the 144 patients,108 （75. 0%） suffered from left lower extremity deep vein thrombosis, 34 （23. 6%） had DVT on the right lower limb and 2 （1. 4%） with bilateral lower limbs DVT. （2）The Wells risk assessment model was more effectively stratified DVT group patients into moderate or higher risk level. This superiority was statistically significant （ P〈0. 05,Wilcoxon Test） . The Wells model was also more effective at assessing risk of DVT among non-DVT group （ P〈0 . 05 , Wilcoxon Test ） . Wells Score had a higher Sensitivity （ 0 . 99 ） and Specificity （ 0 . 86 ） , highest Positive likelihood ratio （ 7 . 22 ） and smallest Negative likelihood ratio （0. 01）. （3）ROC analysis showed that the area under curve （AUC） of Wells Score and RCOG model for DVT were 0. 955±0. 011 （P=0. 000） and 0. 696±0. 030 （P=0. 000）,respectively. No statistically significant was found in the z-analysis for AUC between three models. Conclu-sions：The study demonstrated that the Wells Score is accurate to predict the probability of DVT,which is a useful and practical tool to assessment the risk of DVT among Chinese maternity patients. Furthermore,Wells Score may help obstetricians classified the true extent of risk for a patient and provide appropriate suggestions for thromboprophylaxis according to the risk level.