比较不同VTE风险评分模型对糖尿病患者VTE的预测价值

发布时间：2018-07-17 15:49

【摘要】：目的:(1)探讨Pauda评分、修正的Geneva评分、Caprini评分和Wells PE评分对内科住院的2型糖尿病患者肺血栓栓塞症(PTE)的预测价值;(2)探讨Pauda评分、修正的Geneva评分、Caprini评分和Wells DVT评分对内科住院的2型糖尿病患者深静脉血栓形成(DVT)的预测价值。方法:(1)回顾性收集解放军第474医院2013年1月至2016年4月进行CT肺动脉造影(computed tomographic pulmonary angiography,CTPA)的临床疑诊肺血栓栓塞症的2型糖尿病内科住院患者病例资料。最终收集了167例疑诊PTE的2型糖尿病内科住院患者的病例资料。使用Padua评分、修正的Geneva评分、Caprini评分、Wells PE评分方法对患者进行评分。以上述4种评分评估的分值为结果变量,以CTPA确诊肺栓塞结果为状态变量,绘制ROC曲线。ROC曲线下面积及约登指数越大说明预测价值越高。(2)回顾性收集解放军第474医院2013年1月至2016年6月疑诊DVT且合并2型糖尿病的内科住院患者病例资料,所有入选患者均进行四肢及腹部大血管彩超检查。最终收集了378例疑诊DVT的2型糖尿病内科住院患者的病例资料。使用Padua评分、修正的Geneva评分、Caprini评分、Wells DVT评分方法对患者进行评分。以上述4种评分评估的分值为结果变量,以确诊DVT结果为状态变量,绘制ROC曲线。ROC曲线下面积及约登指数越大说明预测价值越高。结果:(1)167例临床疑诊PTE的2型糖尿病内科住院患者中,男77例、女97例,平均年龄(69.2±9.30)岁。最终确诊为肺血栓栓塞症患者83例,确诊率为49.7%(83/167),PTE组和非PTE组比较,年龄、心率、肿瘤、卧床、既往VTE病史、心衰、呼衰、单侧下肢深静脉触痛伴下肢水肿、急性心肌梗塞、正在接受激素治疗、急性感染有统计学差异(P0.05)。Padua评分、修正的Geneva评分、Caprini评分、Wells PE评分诊断2型糖尿病内科住院患者合并PTE的ROC曲线下面积分别为0.797±0.034、0.651±0.042、0.724±0.039、0.726±0.039,灵敏度分别为56.63%、89.16%、49.4%、78.31%,特异度分别为94.05%、36.9%、88.1%、63.1%,约登指数分别为0.51、0.26、0.37、0.41,最佳分界值分别为4分、3分、6分、1分。上述四种评分ROC曲线下面积比较结果如下:修正Geneva评分与Padua评分比较差异有统计学意义(P0.0083),Padua评分与Caprini评分、Wells PE评分比较差异无统计学意义(P0.0083),修正的Geneva评分与Caprini评分、Wells PE评分比较差异无统计学意义(P0.0083),Padua评分与Wells PE评分比较差异无统计学意义(P0.0083)。(2)378例疑诊DVT的2型糖尿病内科住院患者中,男199例、女179例,平均年龄(65.9±12)岁,最终确诊DVT患者95例,确诊率25.1%(95/378),95例DVT患者中,年龄大于40岁者93例,占97.7%,D-二聚体阳性者90例,占94.7%,心率大于或等于75次/分81例,占85.3%,单侧下肢疼痛80例,占84.2%,单侧下肢深静脉触痛伴水肿78例,占82.1%,急性感染74例,占77.9%,体重指数大于25kg/m2 48例,占50.5%;Padua评分、修正的Geneva评分、Caprini评分、Wells DVT评分诊断2型糖尿病内科住院患者合并DVT的ROC曲线下面积分别为0.795±0.022、0.884±0.0237、0.623±0.0303、0.854±0.022,灵敏度分别为85.26%、80.00%、72.63%、82.11%,特异度分别为70.67%、90.11、49.47%、81.63%,约登指数分别为0.56、0.70、0.22、0.64,最佳分界值分别为2分、7分、3分、1分;四种评分ROC曲线下面积两两比较:Padua评分与Wells DVT评分比较差异无统计学意义(P0.0083),Padua评分与Caprini评分、修正的Geneva评分比较差异有统计学意义(P0.0083),Caprini评分与修正的Geneva评分、Wells DVT评分比较差异有统计学意义(P0.0083),修正的Geneva评分与Wells DVT评分比较差异无统计学意义(P0.0083)。结论:(1)Padua评分、修正的Geneva评分、Caprini评分和Wells PE评分在一定程度上均可预测2型糖尿病内科住院患者肺血栓栓塞症的发生风险。Padua评分预测价值最高,修正的Geneva评分预测价值最小,Wells PE评分、Caprini评分预测价值稍低于Padua评分,但四种评分预测价值有限,均未达优秀。(2)Padua评分、修正的Geneva评分、Caprini评分和Wells DVT评分均能在一定程度上预测2型糖尿病内科住院患者DVT的发生风险。四种评分预测价值由大到小分别为修正的Geneva评分Wells DVT评分Padua评分Caprini评分,修正的Geneva评分预测价值最高,可达优秀。Wells DVT评分略高于Padua评分,但两者比较无统计学差异,预测价值相当,均可达中等以上,Caprini评分预测价值较差。
[Abstract]:Objective: (1) to explore the predictive value of Pauda score, modified Geneva score, Caprini score, and Wells PE score on pulmonary thromboembolism (PTE) in patients with type 2 diabetes in internal medicine; (2) discuss the Pauda score, modified Geneva score, Caprini score, and Wells DVT score for deep venous thrombosis (DVT) in patients with type 2 diabetes hospitalized in internal medicine Methods: (1) a retrospective collection of clinical data of patients with type 2 diabetes in clinical suspected pulmonary thromboembolism by CT pulmonary angiography (computed tomographic pulmonary angiography, CTPA) from January 2013 to April 2016 of the 474th Hospital of the PLA was collected. Finally, 167 hospitalized patients with type 2 diabetes mellitus, suspected of PTE, were collected. The Padua score, the modified Geneva score, the Caprini score, and the Wells PE score were used to score the patients. The results of the above 4 assessment were the result variables, and the result of pulmonary embolism was confirmed by CTPA as the state variable. The greater the area and the Jordan index of the ROC curve.ROC curve, the higher the predictive value was. (2) retrospective analysis. The data of hospitalized patients with suspected DVT and type 2 diabetes in the 474th Hospital of the PLA from January 2013 to June 2016 were collected. All the patients were examined with color Doppler ultrasound on the limbs and abdomen. Finally, the data of 378 cases of type 2 diabetes inpatients with suspected DVT were collected. The Padua score and the revised Geneva evaluation were used. The score of the Caprini score and the Wells DVT score was scored. The score of the above 4 assessment was the result variable, and the result of the diagnosis of DVT was the state variable. The greater the area and the Jordan index of the ROC curve.ROC curve, the higher the predictive value. The results were: (1) among the 167 patients with type 2 diabetes in the clinical suspected PTE, the male 77 was 77. 97 cases, 97 women, average age (69.2 + 9.30) years. The final diagnosis was 83 cases of pulmonary thromboembolism, the rate of diagnosis was 49.7% (83/167). The age, heart rate, heart rate, heart rate, heart rate, bed, past VTE history, heart failure, respiratory failure, unilateral deep venous touch with lower limb edema, acute myocardial infarction, and acute myocardial infarction were being treated with hormone treatment. The statistical difference (P0.05).Padua score, the modified Geneva score, the Caprini score, and the Wells PE score were used to diagnose the area under the ROC curve of the internal medicine patients of type 2 diabetes with the ROC curve of PTE, respectively, and the sensitivity was 56.63%, 89.16%, 49.4%, 78.31% respectively, and the specificity was 94.05%, 36.9%, 88.1%, 63.1, respectively. %, 0.51,0.26,0.37,0.41, the best dividing values were 4, 3, 6, 1. The comparison of the area under the above four ROC curves was as follows: the difference between the revised Geneva score and the Padua score was statistically significant (P0.0083), the Padua score and the Caprini score, and the Wells PE score had no statistically significant difference (P0.0083), and there was no statistical significance (P0.0083). There was no significant difference between the positive Geneva score and the Caprini score, and the Wells PE score was not statistically significant (P0.0083), and there was no significant difference between the Padua score and the Wells PE score (P0.0083). (2) among the 378 cases of type 2 diabetes in the hospitalized patients with suspected DVT, there were 199 males and 179 females, the average age was (65.9 + 12) years, and the final confirmed DVT patients were 95, and the diagnosis rate was 25.1. % (95/378), of 95 patients with DVT, 93 cases were older than 40 years old, accounting for 97.7%, 90 cases of D- two polymer positive, 94.7%, heart rate greater than or equal to 75 / 81 cases, 85.3%, 80 cases of unilateral lower extremity pain, 84.2%, unilateral lower limb deep vein touch with edema 78 cases, acute infection cases, accounting for 25kg/m2 The a score, the modified Geneva score, the Caprini score, and the Wells DVT score were used to diagnose the area under the ROC curve of the hospitalized patients with type 2 diabetes, 0.795 + 0.022,0.884 + 0.0237,0.623 + 0.0303,0.854 + 0.022 respectively, and the sensitivity was 85.26%, 80%, 72.63%, 82.11% respectively, and the specificity was 70.67% respectively, 90.11,49.47%, 81.63%, and the Jordan index, respectively. For 0.56,0.70,0.22,0.64, the best dividing values were 2 points, 7 points, 3 points, 1 points, and 22 comparison of the area under the four ROC curves: the difference between the Padua score and the Wells DVT score was not statistically significant (P0.0083), the Padua score and Caprini score, and the revised Geneva score were statistically significant (P0.0083), Caprini score and amended Geneva The scores of Wells DVT scores were statistically significant (P0.0083), and there was no significant difference between the revised Geneva score and Wells DVT score (P0.0083). (1) the Padua score, the modified Geneva score, the Caprini score, and the Wells PE score could predict the pulmonary thromboembolism in patients with type 2 diabetes in a certain degree. The value of the risk.Padua score is the highest, the revised Geneva score is the least predictive value, Wells PE score, and the Caprini score is a little lower than the Padua score, but the four kinds of score prediction value are limited. (2) the Padua score, the modified Geneva score, the Caprini score and the Wells DVT score can predict the 2 type sugar to a certain extent. The risk of DVT in the hospitalized patients of urinary disease. The value of the four kinds of scores is from large to small to the modified Geneva score Wells DVT score Padua score Caprini score, and the revised Geneva score is the highest prediction value, and the excellent.Wells DVT score is slightly higher than the Padua score, but there is no statistical difference, and the value of the prediction is equal. Up to medium, the value of Caprini score is poor.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.5;R587.1

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