肺炎患者伴发静脉血栓栓塞症的影响因素研究

Study on influencing factors of venous thromboembolism in pneumonia patients

目的分析静脉血栓栓塞症(VTE)在肺炎患者中的发生率,探讨肺炎伴发VTE风险的评估和防治。方法将肺炎患者根据伴发VTE情况分为对照组(单纯肺炎)和试验组(伴发VTE)。收集患者人口学资料、血常规、凝血指标、肝肾功能指标和血气指标等。2组单因素的比较用卡方检验、t检验及非参数秩和检验等统计学方法,对多因素比较用Logistic回归分析。根据Logistic回归结果建立诺模图,计算受试者工作特征(ROC)曲线。结果对照组纳入106例,试验组纳入29例。2组患者经单因素分析发现,年龄、D-二聚体、纤维蛋白原降解产物、白细胞计数、中性粒细胞数、白蛋白-球蛋白比值在统计学上差异均有统计学意义(均P<0.05)。构建多因素Logistic回归方程,结果发现:年龄[比值比(OR)=1.052]、D-二聚体(OR=2.339)和白蛋白/球蛋白(OR=0.042)是肺炎伴发VTE的独立影响因素。建立诺模图、计算ROC曲线,曲线下面积(AUC)为0.754。结论高龄、D-二聚体升高和白蛋白-球蛋白比值降低是肺炎患者发生VTE的独立危险因素,且建立的预测模型具有良好的准确性。

Objective To analyze the incidence of venous thromboembolism(VTE)in pulmonary patients and explore the assessment and prevention of the risk of pneumonia accompanied VTE.Methods The patients with pneumonia were divided into control group(simple pneumonia)and treatment group(with VTE)according to the condition of VTE.Demographic data,blood routine,coagulation index,liver and kidney function index and blood gas index were collected.Statistical methods like chi square test,t-test and nonparametric rank sum test were applied to compare the differences between the two groups.Finally,the nomogram was established according to the logistic regression results and the receiver operating characteristic(ROC)curve was calculated.Results 106 cases in control group and 29 cases in treatment group.Univariate analysis showed that age,D-dimer,fibrinogen degradation products,white blood cell count,neutrophil count,albumin-globulin ratio were statistically significant(P<0.05).Multivariate logistic regression analysis suggests that age[odds ratio(OR)=1.052],D-dimer(OR=2.339),and albumin/globulin(OR=0.042)are independent affecting factors for VTE in pneumonia patients.A nomogram was developed and ROC was calculated,the area und er curve(AUC)was 0.754.Conclusion High age,elevated D-dimer and decreased albumin/globulin are independent risk factors for VTE in pneumonia patients.More over,the established prediction model has good accuracy.