D-二聚体联合Caprini评分在老年肺部感染患者静脉血栓栓塞症诊断中价值

Value of D-dimer detection plus Caprini score to the diagnosis of venous thromboembolism in elderly patients with pulmonary infection

目的分析老年肺部感染患者发生静脉血栓栓塞症(venous thromboembolism,VTE)的危险因素,探讨D-二聚体(D-dimer,D-D)联合Caprini评分诊断老年肺部感染患者发生VTE价值。方法住院期间发生VTE老年肺部感染患者116例为VTE组,同期未发生VTE老年肺部感染患者232例为非VTE组,记录2组吸烟史、基础疾病、应用呼吸机、静脉置管情况及入院时白细胞计数、中性粒细胞计数、D-D水平等,应用Caprini风险评估模型计算Caprini评分;采用多因素logistic回归分析老年肺部感染患者发生VTE的影响因素;绘制ROC曲线,评估D-D、Caprini评分诊断老年肺部感染患者发生VTE的效能。结果VTE组有基础疾病、应用呼吸机、静脉置管比率(32.8%、12.1%、13.8%)、白细胞计数[(10.24±3.83)×10^(9)/L]、中性粒细胞计数[(8.23±3.77)×10^(9)/L]、C反应蛋白[(65.16±58.56)mg/L]、D-D[(3.47±2.99)mg/L]水平、Caprini评分[(7.96±3.55)分]均高于非VTE组[17.2%、4.3%、5.6%、(7.25±3.10)×10^(9)/L、(4.88±2.94)×10^(9)/L、(40.30±27.07)mg/L、(0.94±0.89)mg/L、(4.29±1.89)分](P<0.05),吸烟比率、血小板计数、纤维蛋白原水平与非VTE组比较差异均无统计学意义(P>0.05)。D-D(OR=1.974,95%CI:1.371~2.841,P<0.001)、Caprini评分(OR=1.438,95%CI:1.186~1.745,P<0.001)是老年肺部感染患者发生VTE的影响因素。D-D、Caprini评分分别以2.085 mg/L、5.5分为最佳截断值,单独及联合诊断老年肺部感染患者发生VTE的AUC分别为0.830(95%CI:0.756~0.903,P<0.001)、0.808(95%CI:0.735~0.881,P<0.001)、0.893(95%CI:0.837~0.950,P<0.001),灵敏度分别为63.8%、67.2%、72.4%,特异度分别为91.4%、82.8%、93.1%;D-D联合Caprini评分诊断老年肺部感染患者发生VTE的AUC均高于二者单独诊断(Z=1.892,P=0.038;Z=3.163,P=0.016),D-D与Caprini评分诊断老年肺部感染患者发生VTE的AUC比较差异无统计学意义(Z=0.425,P=0.671)。结论D-D水平和Caprini评分高的老年肺部感染患者发生VTE风险大;D-D联合Caprini风险评估模型诊断老年肺部感染患者发生VTE有较高价值。

Objective To analyze the risk factors of venous thromboembolism(VTE)in elderly patients with pulmonary infection,and to investigate the value of D-dimer(D-D)detection plus Caprini score to the diagnosis of VTE in the elderly patients with pulmonary infection.Methods In 116 elderly patients with pulmonary infection,116 patients developed VTE during hospitalization(VTE group),and 232 patients developed no VTE(non-VTE group).The smoking history,underlying diseases,ventilator application,venous catheterization,white blood cell count,neutrophil count,and serum D-D level on admission were recorded,and the Caprini risk assessment model was used to calculate the Caprini score.Multivariate logistic regression was done to analyze the influencing factors of VTE in elderly patients with pulmonary infection.The ROC curves were drawn to evaluate the efficiencies of D-D level and Caprini score on diagnosing VTE in elderly patients with pulmonary infection.Results The proportions of VTE patients with underlying diseases,ventilator application and venous catheterization,white blood cell count,neutrophil count,C-reactive protein level,D-D level and Caprini score were higher in VTE group[32.8%,12.1%,13.8%,(10.24±3.83)×10^(9)/L,(8.23±3.77)×10^(9)/L,(65.16±58.56)mg/L,(3.47±2.99)mg/L,7.96±3.55]than those in non-VTE group[17.2%,4.3%,5.6%,(7.25±3.10)×10^(9)/L,(4.88±2.94)×10^(9)/L,(40.30±27.07)mg/L,(0.94±0.89)mg/L,4.29±1.89](P<0.05),and there were no significant differences in the smoking rate,platelet count and fibrinogen level between two groups(P>0.05).D-D level(OR=1.947,95%CI:1.371-2.841,P<0.001)and Caprini score(OR=1.438,95%CI:1.186-1.745,P<0.001)were the influencing factors of VTE in elderly patients with pulmonary infection.When the optimal cut-offvalues of D-D level and Caprini score were 2.085 mg/L and 5.5,the AUCs of single and combined application of them two for diagnosing VTE in elderly patients with pulmonary infection were 0.830(95%CI:0.756-0.903,P<0.001),0.808(95%CI:0.735-0.881,P<0.001)and 0.893(95%CI:0.837-0.950,P<0.001),the sensitivities were 63.8%,67.2%and 72.4%,and the specificities were 91.4%,82.8%and 93.1%,respectively.The AUCof combined application of them two was higher than that of single application of D-D level(Z=1.892,P=0.038)and Caprini score(Z=3.163,P=0.016),and there was no significant difference between the AUCof D-D level and Caprini score(Z=0.425,P=0.671).Conclusion High D-D level and Caprini score indicate a high risk of VTE in elderly patients with pulmonary infection,and the combination of D-D level and Caprini risk assessment model has a high diagnostic value.