摘要
目的探讨Caprini评分、D-二聚体联合血栓弹力图(thromboelastogram,TEG)对中晚期肺癌患者静脉血栓栓塞症(venous thromboembolism,VTE)发生的预测价值。方法选取2019年3月至2022年9月南京大学医学院附属鼓楼医院收治的39例合并VTE的中晚期肺癌患者和50例未合并VTE的中晚期肺癌患者为研究对象,分别归为VTE组和无VTE组。比较两组患者的Caprini评分、血D-二聚体水平及TEG参数[凝血反应时间(reaction time,R)、血液凝固时间(clotting time,K)、凝固角(α角)、最大振幅(maximum amplitude,MA)],采用多因素Logistic回归分析探讨全部患者VTE形成的独立影响因素,采用受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)的曲线下面积(area under the curve,AUC)评估各参数对VTE的预测价值。结果VTE组39例患者均存在下肢深静脉血栓,其中5例(12.8%)合并肺栓塞,64.1%的患者无明显不适主诉。全部VTE患者均予以抗凝、溶栓等对症处理,3例(7.7%)患者因肺栓塞死亡。VTE组患者的Caprini评分、极高危患者的比例、血D-二聚体水平均显著高于无VTE组(均P<0.05),α角、MA均显著大于无VTE组(均P<0.05),两组患者的性别、年龄、体重指数等临床特征比较差异均无统计学意义(均P>0.05)。多因素Logistic回归分析结果表明,Caprini评分、血D-二聚体水平、α角、MA均为中晚期肺癌患者VTE发生的独立影响因素(均P<0.05)。ROC曲线分析结果表明,Caprini评分、血D-二聚体水平、α角、MA对中晚期肺癌患者VTE的发生均有一定预测价值(AUC>0.7),其中Caprini评分的预测价值最高(AUC>0.9)。结论Caprini评分、血D-二聚体水平、TEG均能有效预测中晚期肺癌患者VTE的发生,其中Caprini评分的预测价值最高。
Objective To analyze the predictive value of Caprini score,D-dimer combined with thromboelastography(TEG)in the occurrence of venous thromboembolism(VTE)in patients with middle-advanced stage lung cancer.Method Thirty-nine middleadvanced stage lung cancer patients with VTE and 50 middle-advanced stage lung cancer patients without VTE who were admitted to Nanjing Drum Tower Hospital rom March 2019 to September 2022 were enrolled for the study as VTE group and non-VTE group respectively.The Caprini score,blood D-dimer level and TEG parameters[reaction time(R),clotting time(K),coagulation angle(α)and maximum amplitude(MA)]were compared between the two groups.Multivariate Logistic regression was used to analyze the independent influencing factors of VTE in all patients.The area under the curve(AUC)of receiver operator characteristic(ROC)curve was performed to evaluate the predictive value of each parameter on VTE.Result In VTE group,39 patients suffered from deep venous thrombosis of lower limbs,of which 5 patients(12.8%)were complicated with pulmonary embolism,and 64.1%patients had no obvious complaints of discomfort.All patients with VTE were treated with anticoagulation and thrombolysis,and 3 cases(7.7%)died of pulmonary embolism.Caprini score,the proportion of extremely high-risk patients,blood D-dimer level in VTE group were significantly higher than those in non-VTE group(all P<0.05),αand MA were significantly larger than those in non-VTE group(all P<0.05).Multivariate Logistic regression analysis showed that Caprini score,blood D-dimer level,αand MA were the independent influencing factors of VTE(all P<0.05).ROC curve analysis results showed that Caprini score,blood D-dimer level,αand MA had certain predictive value(AUC>0.7),of which Caprini score had the highest predictive value(AUC>0.9).Conclusion Caprini score,blood D-dimer level and TEG can effectively predict the occurrence of VTE in patients with middle-advanced stage lung cancer,among them,Caprini score has the highest predictive value.
作者
杨言
夏萍
毛玉琴
陈亚群
Yang Yan;Xia Ping;Mao Yuqin;Chen Yaqun(Department of Thoracic Surgery,Nanjing Drum Tower Hospital,Nanjing 210008,China)
出处
《肿瘤综合治疗电子杂志》
2023年第3期98-103,共6页
Journal of Multidisciplinary Cancer Management(Electronic Version)
