摘要
背景静脉血栓栓塞症(VTE)是常见的易被低估的血管性疾病,临床实际工作中发现现有的检测方式以及风险评估效果有限。平均血小板体积(MPV)可能是深静脉血栓(DVT)重要的生物标志物之一。Padua评分和MPV均为基层医院廉价、易获得的指标,研究两项指标对D-二聚体>500μg/L的非手术住院患者发生VTE的预测价值具有重要临床意义。目的研究Padua评分联合MPV对D-二聚体>500μg/L的非手术住院患者发生VTE的预测价值。方法回顾性分析合肥市第二人民医院2017年2月-2019年4月收治的临床高度疑似VTE且D-二聚体>500μg/L的非手术住院患者,完善CT肺动脉造影(CTPA)或双下(上)肢加压深静脉彩超或深静脉造影检查。按照研究标准将患者分为VTE组和非VTE组。收集两组患者的基线资料,包括年龄、性别、心率(HR)、D-二聚体、Padua评分、血小板计数(PLT)、MPV、血小板分布宽度(PDW)、血小板压积(PCT)、平均红细胞体积(MCV)。比较两组患者的基线资料。将基线资料纳入单因素Logistic回归分析,筛选D-二聚体>500μg/L的非手术住院患者发生VTE的影响因素,将Logistic回归分析结果中P<0.1的变量纳入多因素Logistc回归分析进一步筛选其影响因素。采用ROC曲线评估各指标对D-二聚体>500μg/L的非手术住院患者发生VTE的预测价值。结果VTE组和非VTE组基线资料中Padua评分、MPV比较,差异有统计学意义(P<0.01)。多因素Logistic回归分析结果显示,Padua评分〔OR=1.930,95%CI(1.326,2.809),P=0.001〕、MPV〔OR=2.566,95%CI(1.482,4.444),P=0.001〕是D-二聚体>500μg/L的非手术住院患者发生VTE的影响因素。对于D-二聚体>500μg/L的非手术住院患者发生VTE的情况,Padua评分对其预测的ROC曲线下面积(AUC)为0.723〔95%CI(0.607,0.839)〕,最佳截断值≥4.5分,灵敏度为0.600,特异度为0.815,约登指数为0.41;MPV对其预测的AUC为0.771〔95%CI(0.661,0.881)〕,最佳截断值≥10.35 fl,灵敏�
Background Venous thromboembolism(VTE)is a common underrated vascular disease,but clinical detection methods and risk assessment for it are used insufficiently.Mean platelet volume(MPV)may be one of the important biomarkers for deep venous thrombosis(DVT).Both Padua prediction score and MPV are easily measured parameters with low cost in primary hospitals,and it is of clinical significance to study their combination predictive value for VTE in non-surgical inpatients with D-dimer>500μg/L.Objective To evaluate the combination predictive value of Padua prediction score and MPV for VTE in non-surgical inpatients with D-dimer>500μg/L.Methods A retrospective analysis was performed on the nonsurgical inpatients with highly suspected VTE and D-dimer>500μg/L selected from the Second People's Hospital of Hefei from February 2017 to April 2019.All of them underwent CT pulmonary angiography or compression ultrasound or venography of the veins in both upper(lower)limbs.Patients were divided into VTE group and non VTE group according to the study criteria.Baseline data were collected,including age,gender,heart rate,D-dimer,Padua prediction score,platelet,MPV,platelet distribution width,platelet thrombocytocrit and mean red blood cell volume.For identifying the risk factors for VTE,baseline parameters were analyzed with univariate Logistic regression initially,then the identified variables with P value less than 0.1 were further analyzed with multivariate Logistic regression.ROC curve analysis was carried out to assess the predictive value of Padua prediction score,MPV,and the combination of the two for VTE.Results There were statistically significant differences in mean Padua prediction score and MPV between VTE and non-VTE groups(P<0.01).Multivariate Logistic regression analysis showed that Padua prediction score〔OR=1.930,95%CI(1.326,2.809),P=0.001〕and MPV〔OR=2.566,95%CI(1.482,4.444),P=0.001〕were the influencing factors for VTE.For predicting VTE,the AUC of Padua prediction score was 0.723〔95%CI(0.607,0.839)〕,
作者
董琳
雷祖宝
许萍
杨万春
DONG Lin;LEI Zubao;XU Ping;YANG Wanchun(Department of Respiratory and Critical Diseases,the Second People's Hospital of Hefei,Hefei 230011,China)
出处
《中国全科医学》
CAS
北大核心
2020年第15期1910-1915,共6页
Chinese General Practice
