改良Caprini血栓风险评估量表预测妊娠相关静脉血栓栓塞疾病的价值

The Value of the Modified Caprini Risk Assessment Model in Predicting Pregnancy Associated Venous Thromboembolism

目的:探讨改良Caprini血栓风险评估量表预测妊娠相关静脉血栓栓塞疾病(pregnancy associated venous thromboembolism,PA-VTE)的价值。方法:采用病例对照研究,以2012年10月—2019年10月在北京大学第三医院产科住院的49例PA-VTE病例为研究组,随机抽取同期非PA-VTE病例98例作为对照组。比较2组在改良Caprini血栓风险评估量表PA-VTE发病危险因素中的差异;利用Caprini血栓风险评估量表及改良Caprini血栓风险评估量表对2组病例进行PA-VTE发病风险评分及危险度分级,分析危险度分级与PA-VTE发病风险的相关性;同时评估改良Caprini血栓风险评估量表对PA-VTE的预测能力。结果:①年龄、体质量指数(BMI)≥25 kg/m2、早产、胎儿生长受限、择期剖宫产、卧床、遗传性易栓症、内科合并症、深静脉血栓或肺栓塞病史是PA-VTE发生的主要危险因素(均P<0.05)。②Caprini血栓风险评估量表及改良Caprini血栓风险评估量表的危险度分级与PA-VTE发病均存在显著的“剂量反应”关系(趋势P<0.001),即随着危险度分级的升高,PA-VTE的发生风险随之升高。③截断值为3分时,Caprini及改良Caprini血栓风险评估量表对PA-VTE的预测价值最大,敏感度分别为0.531和0.694,差异有统计学意义(P=0.021)。结论:Caprini及改良Caprini血栓风险评估量表均可用于预测PA-VTE的发生,但改良Capirini血栓风险评估量表预测PA-VTE的敏感度更高。

Objective:To investigate the predictive value of the modified Caprini risk assessment model for pregnancy associated venous thromboembolism(PA-VTE).Methods:A retrospective case-control study was conducted,in which 49 PA-VTE inpatients from October 2012 to October 2019 in the obstetrics department of Peking University Third Hospital were the study group,and 98 non-PA-VTE cases were randomly selected as the control group.The differences between the two groups of PA-VTE risk factors in the modified Caprini risk assessment model were compared.The PA-VTE risk score and risk classification of patients in the two groups were analyzed by Caprini risk assessment model and the modified Caprini risk assessment model,and the correlation between risk classification and the occurrence of PA-VTE was analyzed.The predictive ability of the modified Caprini risk assessment model for PA-VTE was also evaluated.Results:①Age,BMI≥25 kg/m2,preterm birth,fetal growth restriction,selective cesarean section,bed rest,hereditary embolism,medical complications,history of thrombosis or pulmonary embolism were the main risk factors for PA-VTE(P<0.05).②There is a significant"dose-response"relationship between the risk classification and the occurrence of PA-VTE in both Caprini and modified Caprini risk assessment models(P for trend<0.001),that is,the risk of PA-VTE increases with the increase of risk classification.③When the cut-off value was 3 points,the predictive value of Caprini and the modified Caprini risk assessment model for PA-VTE was the highest,with sensitivity of 0.531 and 0.694,respectively,and the difference was statistically significant(P=0.021).Conclusions:Both Caprini and the modified Capirini risk assessment model can be used to predict the occurrence of PA-VTE,but the modified Capirini risk assessment model has a higher sensitivity in predicting the occurrence of PA-VTE.