Padua评分模型和出血风险评估模型在行经内镜逆行胰胆管造影术老年胆总管结石患者静脉血栓栓塞症和出血风险因素分析中的应用

Using the Padua prediction score and the bleeding risk score for the assessment of venous thromboembolism and hemorrhage risk factors in elderly patients with choledocholithiasis undergoing endoscopic retrograde cholangiopancreatography

目的探讨Padua评分及出血风险评估模型在行经内镜逆行胰胆管造影术(ERCP)的老年胆总管结石患者静脉血栓栓塞症(VTE)和出血风险因素分析中的应用。方法回顾性分析2017年9月至2019年9月新疆医科大学第一附属医院消化科收治的171例行ERCP治疗的老年胆总管结石患者临床资料,研究VTE、出血危险因素及发生情况,评估Padua风险评估及出血风险评估模型对患者进行VTE及出血分层的应用价值。结果171例患者均顺利完成手术,18例发生并发症,包括术后胰腺炎(9例)、胆道感染(4例)、出血(3例)、VTE事件(2例),不同年龄分层的老年患者均有术后并发症发生,但发生率差异无统计学意义(P>0.05)。根据评估模型,32.7%(56/171)为VTE高危患者,15.2%(26/171)为出血高危患者,2例VTE事件均发生在高危组,3例出血事件中2例发生在低危组、1例发生在高危组。高危组及低危组患者并发症的发生率差异均无统计学意义(χ^(2)=0.000、2.867,P=1.000、0.090)。Logistic回归分析结果显示,Padua风险评估模型(OR=8.383、95%CI:0.926~75.869、P=0.059)、出血风险评估模型(OR=2.860、95%CI:0.250~32.740、P=0.398)并非发生VTE/出血的影响因素。结论对于老年胆总管结石行ERCP患者,Padua评分及出血风险评估模型风险预测能力有限,需要更注重恶性肿瘤、既往VTE病史这两项VTE风险因素及抗血栓药物服用史的出血风险。

Objective To analyze the value of the Padua prediction score and the bleeding risk score in the risk assessment of venous thromboembolism(VTE)and hemorrhage in elderly patients with choledocholithiasis during endoscopic retrograde cholangiopancreatography(ERCP).Methods Clinical data of 171 elderly patients with choledocholithiasis treated with ERCP at the Affiliated Hospital of Xinjiang Medical University from September 2017 to September 2019 were retrospectively analyzed.The Padua prediction score and bleeding risk score were used to evaluate the occurrence of VTE and hemorrhage risk stratification.Results Of all patients treated with the procedure,18 of them had complications after surgery,including postoperative pancreatitis(9 cases),biliary infections(4 cases),hemorrhage(3 cases)and VTE events(2 cases).In addition,complications occurred in elderly patients in different age groups,with no significant difference in incidence(all P>0.05).Evaluation models showed that 32.7%(56/171)were at high risk for VTE,and 15.2%(26/171)were at high risk for hemorrhage.Furthermore,2 VTE events occurred in the high-risk group and,of 3 hemorrhage events,2 were occurred in the low-risk group and 1 in the high-risk group.There was no significant difference in the incidence of complications between the high-risk group and the low-risk group(χ2=0.000,2.867,P=1.000,0.090).Logistic regression analysis results showed that scores of the two assessment models were not influencing factors for VTE/hemorrhage(Padua prediction score:OR=8.383,95%CI:0.926-75.869,P=0.059;bleeding risk score:OR=2.860,95%CI:0.250-32.740,P=0.398).Conclusions For elderly choledocholithiasis patients treated with ERCP,the Padua prediction score and the bleeding risk score have limited ability for risk assessment.More attention needs to be paid to the two VTE risk factors,i.e.,malignant tumors and previous VTE history,in addition to previous bleeding risk for antithrombotic therapy.