改良Padua风险评估模型对评估内科住院患者静脉血栓栓塞症风险有效性研究

Validity of modified Padua risk assessment model in identifying high venous thromboembolism risk among hospitalized medical patients

目的:回顾性验证改良Padua风险评估模型在内科住院患者中筛选静脉血栓栓塞症(VTE)的有效性。方法:采用回顾性病例对照研究设计,以2013年1月至2016年12月在广州医科大学附属第一医院内科住院患者中确诊为VTE的432例患者作为VTE组,以随机数字表法选取同时期同科室的出院诊断非VTE的864例内科住院患者为对照组,回顾性收集2组患者病史、实验室检查结果等临床资料,对所有患者进行Padua风险评估模型以及改良Padua风险评估模型评分,比较2种风险评估模型评分情况。结果:VTE组患者Padua风险评估模型评分高于对照组[(2.92±0.18)分比(1.25±0.10)分,t=16.241,P<0.05]。VTE组患者改良Padua风险评估模型评分高于对照组[(3.27±0.19)分比(1.64±0.11)分,t=14.245,P<0.05]。2组患者随着2种风险评估模型评分的升高,发生VTE的风险也相应增高,经Padua风险评估模型以及改良Padua风险评估模型判定为VTE高危患者(评分≥4分)发生VTE的风险分别是低危患者的12.72倍(95%CI:9.00~17.98,P<0.05)与8.17倍(95%CI:6.00~11.12,P<0.05)。VTE组患者经改良Padua风险评估模型判定为VTE高危患者占比高于Padua风险评估模型(48.61%比39.12%,P<0.05)。结论:改良Padua风险评估模型是基于个体危险因素对内科住院患者进行量化更加有效的VTE风险评估模型。

Objective To retrospectively test the validity of modified Padua risk assessment model in identifying high venous thromboembolism(VTE)risk among hospitalized medical patients.Methods A retrospective case-control study was performed among hospitalized medical patients admitted into the First Affiliated Hospital of Guangzhou Medical University from January 2013 to December 2016.A total of 432 patients with definite VTE during hospitalization were recruited and a tota1 of 864 controls were randomly selected from the patients without VTE admitted into the same department within the same period.The medical history,laboratory examination results and other clinical data of two groups was retrospectively collected.The risks of both groups were retrospectively assessed with the Padua risk assessment model and modified Padua risk assessment model and the two risk assessment models were compared.Results The score of the two risk assessment models in VTE group was significant higher than that in control group(Padua:2.92±0.18 vs 1.25±0.10,t=16.241,P<0.05;modified Padua:3.27±0.19 vs 1.64±0.11,t=14.245,P<0.05).With the increase in risk score,the occurrence of VTE increased accordingly.By Padua risk assessment model and modified Padua risk assessment model,the risk of VTE of high-risk patients was 12.27 times(95%CI:9.00-17.98,P<0.05)and 8.17 times(95%CI:6.00-11.12,P<0.05)as high as that of low-risk patients.The proportion of high-risk patients judged by modified Padua risk assessment model was significant higher than that by Padua risk assessment model(48.61%vs 39.12%,P<0.05).Conclusions Modified Padua risk assessment model can effectively and quantitatively assess the risk of VTE among medical patients based on their individual VTE risk factors.