[1]刘秋瑾,张　凯,刘红杰,等.不同血栓风险评估模型预测经宫腔镜子宫肌瘤切除患者术后深静脉血栓形成的临床价值比较[J].新乡医学院学报,2022,39(1):019-24.[doi:10.7683/xxyxyxb.2022.01.005]
　LIU Qiujin,ZHANG Kai,LIU Hongjie,et al.Comparison of the clinical value of different thrombus risk assessment models in predicting deep vein thrombosis of patients after transcervical resection of myoma[J].Journal of Xinxiang Medical University,2022,39(1):019-24.[doi:10.7683/xxyxyxb.2022.01.005]
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不同血栓风险评估模型预测经宫腔镜子宫肌瘤切除患者术后深静脉血栓形成的临床价值比较
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年1
页码:
019-24
栏目:
临床研究
出版日期:
2022-01-05

文章信息/Info

Title:
Comparison of the clinical value of different thrombus risk assessment models in predicting deep vein thrombosis of patients after transcervical resection of myoma
作者:
刘秋瑾; 张　凯; 刘红杰; 邵　勇
(郑州大学第三附属医院重症医学科，河南　郑州　450000)
Author(s):
LIU Qiujin; ZHANG Kai; LIU Hongjie; SHAO Yong
(Department of Critical Care Medicine,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China)
关键词:
新型G-Caprini血栓风险评估模型; Rogers血栓风险评估模型; 子宫肌瘤; 深静脉血栓形成
Keywords:
new G-caprini thrombus risk assessment modelRogers thrombus risk assessment modelhysteromyomadeep vein thrombosis
分类号:
R473.71
DOI:
10.7683/xxyxyxb.2022.01.005
文献标志码:
A
摘要:
目的　比较新型G-Caprini血栓风险评估模型与Rogers血栓风险评估模型对经宫腔镜子宫肌瘤切除术（TCRM）患者术后深静脉血栓形成（DVT）的预测价值。方法　选择2018年1月至2019年12月在郑州大学第三附属医院行TCRM治疗的80例患者为研究对象，根据其术后是否发生DVT分为DVT组（n=35）和无DVT组（n=45），采用单因素和多因素logistic回归分析患者行TCRM后发生DVT的影响因素。采用新型G-Caprini和Rogers血栓风险评估模型对2组患者术后发生DVT的风险进行评估。采用受试者工作特征（ROC）曲线分析新型G-Caprini和Rogers血栓风险评估模型预测患者行TCRM后发生DVT的价值。结果　2组患者的年龄、体质量指数与子宫肌瘤患者行TCRM后发生DVT无关（P>0.05），合并肺部疾病、卧床时间、下肢水肿、中心静脉置管、DVT或肺栓塞病史、恶性肿瘤病史与子宫肌瘤患者行TCRM后发生DVT有关（P<0.05）。多因素logistic回归分析结果显示，合并肺部疾病、卧床时间、下肢水肿、中心静脉置管、DVT或肺栓塞病史、恶性肿瘤病史是子宫肌瘤患者行TCRM后发生DVT的独立危险因素（P<0.05）。新型G-Caprini血栓风险评估模型中DVT组患者累计血栓风险评分显著高于无DVT组患者（P<0.05）；82.86%的DVT患者被归为高风险，15.56%的无DVT患者被归为高风险，DVT患者被归为高风险的比率显著高于无DVT患者（χ2=7.385，P<0.05）。Rogers血栓风险评估模型中DVT组患者累计风险评分显著高于无DVT组患者（P<0.05）；60.00%的DVT患者被归为高风险，33.33%的无DVT患者被归为高风险，DVT患者被归为高风险的比率显著高于无DVT患者（χ2=5.321，P<0.05）。80例患者中，36例被新型G-Caprinis血栓风险评估模型评估为高风险人群，44例被评估为非高风险人群；36例被评估为高风险人群的患者中有29例发生DVT，44例评估为非高风险人群的患者中有37例未发生DVT，评估准确率为82.50%(66/80)。80例患者中，36例被Rogers血栓风险评估模型评估为高风险人群，44例被评估为非高风险人群；36例被评估为高风险人群的患者中有21例发生DVT，而44例评估为非高风险人群的患者中有29例未发生DVT，评估准确率为62.50%（50/80）。新型G-Caprinis血栓风险评估模型的评估准确率显著高于Rogers血栓风险评估模型（χ2=6.372,P<0.01）。新型G-Caprini和Rogers风险评估模型预测子宫肌瘤患者行TCRM后发生DVT的曲线下面积（AUC）分别为0.784和0.642，特异度分别为87.93%和70.35%，灵敏度分别为86.63%和69.37%，新型G-Caprini风险评估模型的特异度、灵敏度和AUC均显著高于Rogers血栓风险评估模型（χ2=18.772、18.360、21.623，P<0.01）。结论　合并肺部疾病、卧床时间、下肢水肿、中心静脉置管、DVT或肺栓塞病史以及恶性肿瘤病史等因素是子宫肌瘤患者TCRM后发生DVT的独立危险因素，新型G-Caprini血栓风险评估模型在预测子宫肌瘤患者TCRM后发生DVT的应用价值明显优于Rogers血栓风险评估模型。
Abstract:
Objective　To compare the value of new G-Caprini thrombus risk assessment model and Rogers thrombus risk assessment model in predicting deep vein thrombosis(DVT) of patients after transcervical resection of myoma(TCRM).Methods　Eighty patients who underwent TCRM in the Third Affiliated Hospital of Zhengzhou University from January 2018 to December 2019 were selected as the research objects.The patients were divided into DVT group (n=35) and non-DVT group (n=45) according to whether DVT occurred after operation.The factors influencing DVT after TCRM were analyzed by single factor and multiple factor logistic regression analysis.The new G-Caprini and Rogers thrombus risk assessment models were used to assess the risk of postoperative DVT of patients in the two groups.The receiver operating characteristic (ROC) curve was used to analyze the value of new G-Caprini and Rogers risk assessment model in the assessment of DVT of patients after TCRM.Results　The age,body mass index of patients were not related to DVT after TCRM (P>0.05)the combination of pulmonary disease,bed time,lower extremity edema,retention of central vein catheter,history of DVT or pulmonary embolism,history of malignant tumor were related to DVT after TCRM (P<0.05).Multivariate logistic regression analysis showed that the combination of pulmonary disease,bed time,lower extremity edema,retention of central vein catheter,history of DVT or pulmonary embolism,history of malignant tumor were independent risk factor of DVT of patients after TCRM (P<0.05).In the new G-Caprini risk assessment model,the cumulative risk score of patients in the DVT group was significantly higher than that in the non-DVT group (P<0.05).Twenty-nine(82.86%) patients with DVT were classified as high risk,7 (15.56%) patients without DVT were classified as high riskthe rate of patients with DVT classified as high risk was significantly higher than that of patients without DVT (χ2=7.385,P<0.05).In the Rogers risk assessment model,the cumulative risk score of patients in the DVT group was higher than that in the non-DVT group (P<0.05).Twenty-one(60.00%) DVT patients were classified as high risk,15(33.33%) patients without DVT were classified as high riskthe rate of patients with DVT classified as high risk was significantly higher than that of patients without DVT (χ2=5.321，P<0.05).Of the 80 patients,36 cases were assessed as high risk population and 44 cases as non-high risk population by the new G-Caprinis thrombus risk assessment model29 cases of the 36 patients developed DVT,and 37 cases of the 44 patients did not develop DVTthe assessment accuracy rate of G-Caprinis thrombus risk assessment model was 82.50%(66/80).Of the 80 patients,36 cases were assessed as high risk population by Rogers thrombus risk assessment model and 44 cases were assessed as non-high risk population21 cases of the 36 patients developed DVT,and 29 cases of the 44 patients did not develop DVTthe assessment accuracy rate of G-Caprinis thrombus risk assessment model was 62.50%(50/80).The assessment accuracy of the new G-Caprinis thrombus risk assessment model was significantly higher than that of Rogers thrombus risk assessment model (χ2=6.372,P<0.01).The area under curve(AUC) of new G-Caprini and Rogers risk assessment models in evaluating the DVT of patients after TCRM was 0.784 and 0.642,the specificity was 87.93% and 70.35%,the sensitivity was 86.63% and 69.37%,respectivelythe specificity,sensitivity and AUC of the new G-Caprini risk assessment model were all higher than those of the Rogers risk assessment model(χ2=18.772,18.360,21.623P<0.01).Conclusion　The combination of pulmonary disease,bed time,lower extremity edema,retention of central vein catheter,history of DVT or pulmonary embolism,history of malignant tumor are independent risk factor of DVT of patients with hysteromyoma after TCRM.The application value of the new G-Caprini blood embolism risk assessment model in predicting DVT in patients with hysteromyoma after TCRM is significantly better than that of Rogers Evaluation model.

参考文献/References:

［1］　GIULIANI E,AS-SANIE S,MARSH E E.Epidemiology and management of uterine fibroids［J］.Int J Gynaecol Obstet,2020,149(1):3-9.
［2］　MANYONDA I,BELLI A M,LUMSDEN M A,et al.Uterine-artery embolization or myomectomy for uterine fibroids［J］.N Engl J Med,2020,383(5):440-451.
［3］　CAI E,SHAO Y H,SUARTHANA E,et al.A case series of patients with large uterine fibroids and venous thromboembolisms［J］.J Obstet Gynaecol Can,2021,43(3):352-360.
［4］　SPERANZA G,HAGER E.Venous thromboembolism in a patient with an uncommon etiology of May-Thurner syndrome［J］.J Vasc Surg Cases Innov Tech,2021,7(3):549-552.
［5］　LACHARITE-ROBERGE A S,RAZA F,BASHIR R,et al.Case series of seven women with uterine fibroids associated with venous thromboembolism and chronic thromboembolic disease［J］.Pulm Circ,2019,9(1):204-211.
［6］　KUKLIK E,DRELICH-ZBROJA A,KUCZYN′SKA M,et al.Intravenous leiomyomatosis as an unusual cause of the misdiagnosis of deep vein thrombosis［J］.Pol Arch Intern Med,2021,131(1):75-77.
［7］　DASHE J,PARISIEN R L,PINA M,et al.Is the Caprini score predictive of venothromboembolism events in orthopaedic fracture patients［J］.J Orthop Trauma,2019,33(6):269-275.
［8］　CRONIN M，DENGLER N，KRAUSS E S,et al.Completion of the updated Caprini risk assessment model (2013 version)［J］ .Clin Appl Thromb Hemost,2019,25(4):1076-1082.
［9］　GUYATT G H,EIKELBOOM J W,GOULD M K,et al.Approach to outcome measurement in the prevention of thrombosis in surgical and medical patients:antithrombotic therapy and prevention of thrombosis,9th ed: American college of chest physicians evidence-based clinical practice guidelines［J］.Chest,2012,141(2):185-194.
［10］　WANG M M,QIN X J,HE X X,et al.Comparison and screening of different risk assessment models for deep vein thrombosis in patients with solid tumors［J］.J Thromb Thrombolysis,2019,48(2):292-298.
［11］　DE L A CRUZ M S,BUCHANAN E M.Uterine fibroids:diagnosis and treatment［J］.Am Fam Physician,2017,95(2):100-107.
［12］　BERNARDI E,CAMPORESE G.Diagnosis of deep-vein thrombosis［J］.Thromb Res,2018,163(4):201-206.
［13］　VOGELZANG R L,AHMED I,MCLUCAS B.Uterine-artery embolization or myomectomy for uterine fibroids［J］.N Engl J Med,2020,383(22):2185-2186.
［14］　WALLACE K,ZHANG S,THOMAS L,et al.Comparative effectiveness of hysterectomy versus myomectomy on one-year health-related quality of life in women with uterine fibroids［J］.Fertil Steril,2020,113(3):618-626.
［15］　LIM W H,COHEN S C,LAMARO V P.Intra-abdominal haemorrhage from uterine fibroids:a systematic review of the literature［J］.BMC Surg,2020,20(1):70-78.
［16］　JORGE A,SANCHEZ P G,HAYANGA J W A,et al.Routine deep vein thrombosis screening after lung transplantation:incidence and risk factors［J］.J Thorac Cardiovasc Surg,2020,159(3):1142-1150.
［17］　CHEN S H,XU W W,SONG S Q,et al.Efficacy of self-heating calf sleeves for preventing deep vein thrombosis in lung cancer patients who undergo video-assisted thoracoscopic surgery lobectomy［J］.Ann Palliat Med,2020,9(5):2693-2698.
［18］　WANG X,SONG S,NI R,et al.Effectiveness of intraoperative administration of intermittent pneumatic compression in preventing deep vein thrombosis in lung cancer patients undergoing video-assisted thoracoscopic surgery lobectomy［J］.J Thorac Dis,2019,11(7):2832-2838.
［19］　WONG M P,ZAHARI Z,ABDULLAH M S,et al.Postoperative major surgery patients developing silent deep vein thrombosis:a prospective observational study［J］.J Vasc Nurs,2018,36(4):173-180.
［20］　吴晶静,郭旗,张学军.Caprini和Rogers血栓风险评估模型筛查肺癌患者围术期静脉血栓栓塞症的效果［J］.河北医药,2019,41(18):2740-2743,2748.
WU J J,GUO Q，ZHANG X J．Effectsof Caprini and Rogers thrombosis risk assessment model in screening perioperative venous thromboembolism in patients with lung cancer［J］.Hebei Med J,2019,41(18):2740-2743,2748.
［21］　郭海,方强,黄建鸣,等.Caprini和Rogers血栓风险评估模型在胸外科肺癌患者围手术期应用的验证研究［J］.肿瘤预防与治疗,2019,32(8):660-667.
GUO H，FANG Q，HUANG J M，et al.Application of Caprini and Rogers risk assessment models in the perioperative managementof lung cancer patients［J］.J Cancer Control Treat，2019，32 (8):660-667．
［22］　LIN Y,ZENG Z,LIN R,et al.The Caprini thrombosis risk model predicts the risk of peripherally inserted central catheter-related upper extremity venous thrombosis in patients with cancer［J］.J Vasc Surg Venous Lymphat Disord,2021,9(5):1151-1158.
［23］　KRAUSS E S,SEGAL A,CRONIN M,et al.Implementation and validation of the 2013 Caprini score for risk stratification of arthroplasty patients in the prevention of venous thrombosis［J］.Clin Appl Thromb Hemost,2019,25(2):107-114.
［24］　YAGO H,YAMAKI T,SASAKI Y,et al.Application of the Caprini risk assessment model for evaluating postoperative deep vein thrombosis in patients undergoing plastic and reconstructive surgery［J］.Ann Vasc Surg,2020,65(3):82-89.

更新日期/Last Update: 2022-01-05