Padua评分联合D-二聚体在2型糖尿病内科住院患者静脉血栓栓塞症诊断中的价值研究

发布时间：2018-04-13 06:41

  本文选题：糖尿病 + 静脉血栓栓塞　； 参考：《中国全科医学》2017年29期

【摘要】：目的探讨Padua评分联合D-二聚体对2型糖尿病内科住院患者发生静脉血栓栓塞症(VTE)的诊断价值。方法收集中国人民解放军第四七四医院内分泌科2013年1月—2016年3月临床疑似VTE的2型糖尿病内科住院患者305例,其中确诊VTE组176例,未发生VTE组129例,回顾性分析两组一般资料,并应用受试者工作特征(ROC)曲线分析法比较Padua评分、D-二聚体水平及两者联合时对2型糖尿病内科住院患者发生VTE的诊断价值。结果确诊VTE组的年龄、糖化血红蛋白水平、Padua评分、血浆D-二聚体水平均高于未发生VTE组,而三酰甘油水平低于未发生VTE组,确诊VTE组的心脑血管疾病、急性感染、慢性肺部疾病、恶性肿瘤及既往VTE病史的发生率均高于未发生VTE组(P0.05)。Padua评分诊断2型糖尿病内科住院患者VTE的最佳切点为4分,≥4分时灵敏度为53.41%,特异度为89.15%,约登指数为0.426,ROC曲线下面积为0.713[95%CI(0.655,0.771)];D-二聚体最佳切点为0.5 mg/L,≥0.5 mg/L时灵敏度为84.12%,特异度为51.94%,约登指数为0.361,ROC曲线下面积为0.683[95%CI(0.618,0.743)];Padua评分≥4分联合D-二聚体≥0.5 mg/L时灵敏度为93.75%,特异度为51.94%,约登指数为0.457,ROC曲线下面积为0.801[95%CI(0.748,0.852)]。Padua评分联合D-二聚体诊断2型糖尿病内科住院患者发生VTE的ROC曲线下面积与单独使用Padua评分或D-二聚体比较,差异均有统计学意义(Z=5.768,P0.001;Z=5.624,P0.001);而Padua评分与D-二聚体比较,差异无统计学意义(Z=0.932,P0.05)。结论 Padua评分联合D-二聚体诊断2型糖尿病内科住院患者发生VTE是一种简单有效的风险诊断方法,有助于临床医师早期发现2型糖尿病VTE高危人群。
[Abstract]:Objective to evaluate the diagnostic value of Padua score combined with D-dimer in the diagnosis of venous thromboembolism in inpatients with type 2 diabetes mellitus.Methods 305 patients with type 2 diabetes mellitus were collected from the Endocrinology Department of the 474th Hospital of the Chinese people's Liberation Army from January 2013 to March 2016, including 176 cases of confirmed VTE group and 129 cases of no VTE group.The general data of the two groups were analyzed retrospectively, and the diagnostic value of Padua score, D-dimer level and VTE in in-patients with type 2 diabetes mellitus were compared by using the method of operating characteristics of subjects.Results the age, glycosylated hemoglobin level, plasma D-dimer level and triglyceride level in VTE group were higher than those in VTE group, while triglyceride level was lower than that in VTE group. Cardio-cerebrovascular disease and acute infection were found in VTE group.The incidence of chronic lung disease, malignant tumor and previous history of VTE was higher than that of non-occurring VTE group (P0.05. Padua score). The best cut point for diagnosis of VTE in patients with type 2 diabetes was 4 points.When D- dimer 鈮，

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