Padua评分、血清vWF和IMA水平与脓毒性休克患者发生静脉血栓栓塞症的相关性分析

Correlation analysis between Padua score,serum vWF,IMA levels and the occurrence of venous thromboembolism in patients with septic shock

目的:探究Padua评分、血清血管性假血友病因子(von willebrand factor,vWF)、缺血修饰白蛋白(ischemia modified albumin,IMA)水平与脓毒性休克患者发生静脉血栓栓塞症(venous thromboembolism,VTE)的关系。方法:选取汉中市三二〇一医院2015年3月—2023年8月收治的脓毒性休克患者377例,根据住院期间VTE发生情况,将其分为VTE组(发生VTE者,68例)和非VTE组(未发生VTE者,309例)。收集患者临床资料并进行Padua评分,检测血清vWF、IMA水平,分析脓毒性休克患者Padua评分、血清vWF、IMA水平的相关性,分析Padua评分、血清vWF、IMA水平预测脓毒性休克患者发生VTE的价值及影响发生VTE的因素。结果:VTE组患者急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluation,APACHEⅡ)评分、序贯器官衰竭评分、D-二聚体、Padua评分、血清vWF、IMA水平明显高于非VTE组,差异有统计学意义(P<0.05);脓毒性休克患者Padua评分与血清vWF、IMA水平均呈正相关(P<0.05),血清vWF与IMA水平呈正相关(P<0.05);Padua评分、血清vWF、IMA、三者联合预测脓毒性休克患者发生VTE的曲线下面积(AUC)分别为0.879、0.776、0.756、0.954,三者联合预测的AUC高于Padua评分、血清vWF、IMA各自单独预测的AUC(P<0.05);APACHEⅡ评分高、D-二聚体水平高、Padua评分高、vWF水平高、IMA水平高均是影响脓毒性休克患者发生VTE的独立危险因素(P<0.05)。结论:脓毒性休克并发VTE患者Padua评分、血清vWF、IMA水平均呈高表达,三者联合对脓毒性休克患者发生VTE的预测效能较高,均是影响VTE发生的独立危险因素。

Objective:To explore the relationship between Padua score,serum von willebrand factor(vWF),ischemia modified albumin(IMA) level and the occurrence of venous thromboembolism(VTE) in patients with septic shock.Methods:A total of 377 patients with septic shock admitted to Hanzhong 3201 Hospital from March 2015 to August 2023 were selected,according to the occurrence of VTE during hospitalization,they were divided into VTE group(68 patients with VTE) and non-VTE group(309 patients with no VTE).Clinical data of patients were collected and Padua score was performed.Serum vWF and IMA levels were detected.Analyze the correlation of Padua score,serum vWF and IMA level in patients with septic shock,the value of Padua score,serum vWF and IMA level in predicting the occurrence of VTE in patients with septic shock and the factors affecting the occurrence of VTE.Results:APACHEⅡ,SOFA score,D-dimer,Padua score,serum vWF and IMA levels in VTE group were significantly higher than those in non-VTE group(P<0.05).In septic shock patients,Padua score was positively correlated with serum vWF and IMA levels(P<0.05),and serum vWF was positively correlated with IMA levels(P<0.05).The area under curve(AUC) of Padua score,serum vWF,IMA and the combined prediction of VTE in septic shock patients were 0.879,0.776,0.756 and 0.954,respectively,the AUC predicted by the combination of the three methods was higher than that predicted by Padua score,serum vWF and IMA alone(P<0.05).High APACHEⅡ score,D-dimer level,Padua score,vWF level and IMA level were independent risk factors for the occurrence of VTE in septic shock patients(P<0.05).Conclusion:The Padua score,serum vWF and IMA levels of patients with septic shock complicated with VTE were highly expressed,and the combination of the three factors had a high predictive effect on the occurrence of VTE in patients with septic shock,which were independent risk factors affecting the occurrence of VTE.