4种血栓风险评估模型及D-二聚体对肾病综合征患者血栓形成的预测价值

Four types of thrombosis risk assessment models and the predictive value of D-dimer on thrombosis in patients with nephrotic syndrome

目的探讨Padua、Geneva、Wells、Wells简化版4种静脉血栓风险评估模型及D二聚体对肾病综合征患者静脉血栓栓塞(VTE)的评估价值。方法回顾性分析2020年6月—2022年10月入住东部战区总医院肾脏科,并诊断为肾病综合征的417例患者临床资料,包括年龄、性别、体重指数、心率、病理诊断以及静脉血栓发生情况。按住院期间是否并发VTE,将患者分为VTE组(27例)和非VTE组(390例)。依据各量表评分结合D二聚体,针对原量表推荐分级评价其VTE发生风险,探讨风险分级相关危险因素与VTE发生风险之间的关系。结果4种风险评估模型及D二聚体评估显示,Geneva、Padua、Wells、Wells简化版及D-二聚体在推荐分级后与金标准的Kappa指数分别为0.039,0.243、0.058、0.204、0.267;Wells联合D-二聚体的AUC最高(0.914),约登指数分别为0.736,SE为1.0。结论4种静脉血栓风险评估模型及D二聚体对肾病综合征患者血栓形成的评估中,Wells联合D-二聚体预测能力最佳,可为肾病综合征患者血栓评估预测提供有效工具。

Objective To explore the evaluation value of four kinds of venous thrombosis risk assessment models Padua,Geneva,Wells,Wells simplified version and D-dimer in patients with nephrotic syndrome.Methods Clinical data of 417 patients admitted to Nephrology Department of Eastern Theater General Hospital from June 2020 to October 2022 and diagnosed with nephrotic syndrome were retrospectively analyzed,including age,gender,body mass index,heart rate,pathological diagnosis and venous thrombosis occurrence.The patients were divided into VTE group(27 cases)and non-VTE group(390 cases)according to whether there were concurrent VTE during hospitalization.According to the score of each scale combined with D-dimer,the risk of VTE was evaluated according to the recommended grade of the original scale,and the relationship between the risk factors related to the risk grade and the risk of VTE was discussed.Results Four risk assessment models and D-dimer evaluation showed that the Kappa index of Geneva,Padua,Wells,Wells simplified version and D-dimer was 0.039,0.243,0.058,0.204 and 0.267,respectively,compared with gold standard after recommended classification.Conclusion Among the four venous thrombosis risk assessment models and D-dimer in the evaluation of thrombosis in patients with nephrotic syndrome,Wells combined with D-dimer has the best predictive ability,which can provide an effective tool for the evaluation and prediction of thrombosis in patients with nephrotic syndrome.