比较Autar和Padua两种风险模型在预测癌症患者静脉血栓栓塞症的评估效果

Comparison between Autar and Padua risk assessment models for cancer patients with venous thromboembolism

目的比较Autar和Padua两种风险模型对于评估癌症患者静脉血栓栓塞症的效果。方法选取2015年3月至2017年10月南京医科大学附属肿瘤医院270例癌症住院化疗患者为研究对象,分析静脉血栓栓塞症的危险因素。分别采用Autar和Padua两种风险模型进行风险评估,计算ROC曲线下面积、灵敏度及特异度,以及Cronbach’α系数,并进行一致性比较。结果 logistic回归单因素分析显示,高血压、D-二聚体、Padua分值、手术创伤和静脉血栓栓塞症发生有关;多因素分析显示,D-二聚体是癌症住院化疗患者静脉血栓栓塞症独立高危因素。Autar风险模型灵敏性更高,Padua风险模型特异性高。Autar和Padua两种风险评估模型ROC曲线下面积分别为0.50和0.56,Cronbach’α系数分别为0.48和0.92。结论 Padua风险模型更适用于评估和筛查癌症住院静脉血栓栓塞症高危患者;及早介入预防措施,将有助减少静脉血栓栓塞症发生,降低病死率和医疗费用,提高患者生活质量。

Objective To evaluate the validity of the risk assessment model （RAM） of Autar and Padua in identifying venous thromboembolism （ VTE ） among cancer patients. Methods This retrospective study reviewed a total of 270 hospitalized patients with cancer during chemotherapy from March 2015 to October 2017 in Jiangsu Cancer Hospital. The Aurar and Padua RAMs were implemented and the individual scores of each risk factor were summed to generate a cumulative risk score. The sensitivity, specificity, internal consistency and Cronbach＇ α coefficient of these two models were analyzed. Receiver operating characteristic （ ROC ） curve was plotted to calculate the area under the curve （ AUC ）. Results The logistic regression analysis showed that VTE was associated with hypertension, D-dimer, Padua scale, and surgical trauma （P〈0. 05）. Multivariate analysis showed that D-dimer was an independent high risk factor for VTE in cancer patients with chemotherapy in hospital. The AUC of Aurar and Padua were 0. 50 and 0. 56, respectively. Cronbach＇α coefficient of Aurar and Padua were 0. 48 and 0. 92, respectively. The Aurar risk model had a higher sensitivity than the Padua risk model, however, the Padua risk model had a higher specificity than the Padua risk model. Conclusions The Padua risk model is more suitable for assessing and screening high-risk cancer patients with VTE in hospitals. Early intervention can reduce the incidence of VTE, mortality and medical costs, quality of life in cancer patient should be improved.