摘要
目的:评估Caprini静脉血栓风险评估量表(简称Caprini量表)在妇科恶性肿瘤手术患者中对静脉血栓栓塞症(VTE)的预测效果,分析妇科恶性肿瘤手术患者术后VTE的危险因素,并构建VTE风险预测模型。方法:采用回顾性队列研究分析中山大学肿瘤防治中心2015年1月至2020年12月诊治的妇科肿瘤患者手术后确诊VTE的患者50例(血栓组);对照组根据同期妇科恶性肿瘤并行手术的患者的住院号,通过随机数字表法,按照1∶2的比例随机抽取100例(非血栓组)。对两组患者一般资料与疾病资料进行收集,应用2013版Caprini评分表对患者手术前和手术后血栓风险动态进行评分,应用二元Logistic回归分析独立危险因素并构建风险预测模型。结果:(1)血栓组与非血栓组患者术前、术后Caprini评分差异无统计学意义(P>0.05),但两组患者Caprini评分差值(即Caprini评分术后-术前变化量)差异有统计学意义(P<0.05);两组患者术后Caprini评分风险分级差异存在统计学意义(P<0.05),其中血栓组极高危患者比例高于非血栓组(80%vs 58%)。(2)Logistic回归模型示:D-二聚体(D-D)、围手术期输血史、Caprini评分差值、术后Caprini极高危分级是妇科恶性肿瘤手术患者术后发生VTE的独立危险因素(OR>1.0,P<0.05)。(3)根据纳入研究的独立危险因素所得回归预测模型,回归预测模型、D-D、Caprini评分差值的曲线下面积(AUC)分别为0.928(95%CI 0.882~0.974),0.868(95%CI 0.805~0.931),0.735(95%CI 0.644~0.827)。结论:Caprini量表评分对妇科恶性肿瘤接受手术的患者发生VTE的低、中风险分层效果不显著,但Caprini评分差值的预测效果显著。采用D-D、围手术期输血史、Caprini评分差值、术后Caprini极高危分级构建的风险预测模型对妇科恶性肿瘤患者术后VTE风险的预测效果较好,后续需扩大样本进行验证与完善。
Objective:To evaluate the effect of Caprini Risk Assessment Scale(Caprini Score)in predicting venous thromboembolism(VTE)and analyze the risk factors of VTE in postoperative patients with gynecological malignant tumor,to build a VTE risk prediction model.Methods:This retrospective study included 150 patients with gynecological malignant tumor,admitted to the department of gynecology,Sun Yat-sen University Cancer Center,from January 2015 to December 2020,50 patientswho were diagnosed with postoperative VTE were VTE group;the non-VTE group was based on concurrent surgery for gynecological malignancies during the same period According to the random number table method,100 patients were randomly selected according to the ratio of 1∶2(non-VTE group).The demographic data and disease data of the two groups were collected,applicated the 2013 version of the Caprini risk assessment scale to evaluate the thrombosis risk of two groups patients at preoperative and postoperative,binary logistic regression was used to analyze independent risk factors and construct the prediction model.Results:(1)There was no significant difference inthe score of Caprini risk assessment scale between the two groups of patients atpreoperative and postoperative,but the change of Caprini score between the two groups(the Caprini score of postoperative minus the preoperative score)was significantly different(P<0.05);When we compare the groups of the VTE and non-VTE,significant differencewere observed in the Caprini risk stratification of postoperative(P<0.05),and the stratification of the highest risk patients in VTE group were greater than that in the non-VTE group(80% vs.58%).(2)Logistic regression model showed that D-dimer,perioperative blood transfusion history,the change of Caprini score,and postoperative Caprini highest risk classification were independent risk factors for VTE in postoperative patients with gynecological malignant tumor(OR>1.0,P<0.05).(3)The receiver operating characteristic(ROC)curve was drawn based on the regression predict
作者
赖月容
姜月
蒋超南
刘继红
LAI Yuerong;JIANG Yue;JIANG Chaonan(Department of Gynecology,SunYat-sen University Cancer Center,Guangzhou Guangdong 510060,China)
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2021年第12期918-923,共6页
Journal of Practical Obstetrics and Gynecology
