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北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (4): 625-630. doi: 10.19723/j.issn.1671-167X.2023.04.009

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Padua预测评分和血清白蛋白水平在评估风湿病住院患者静脉血栓栓塞中的应用

彭清1,2,刘佳君2,刘焱2,尚华2,唐果3,韩雅欣4,龙丽2,5,*()   

  1. 1. 成都市第二人民医院风湿免疫科, 成都 610000
    2. 遵义医科大学第一临床学院, 贵州遵义 563000
    3. 重庆市璧山区人民医院风湿免疫科, 重庆 402760
    4. 成都市温江区人民医院风湿免疫科, 成都 610000
    5. 四川省人民医院风湿免疫科, 成都 610000
  • 收稿日期:2020-07-30 出版日期:2023-08-18 发布日期:2023-08-03
  • 通讯作者: 龙丽 E-mail:llllyyyy2012@sina.com
  • 基金资助:
    成都市科技惠民技术研发项目(2015-HM01-00165-SF)

Application of Padua prediction score and serum albumin level in evaluating venous thromboembolism in rheumatic inpatients

Qing PENG1,2,Jia-jun LIU2,Yan LIU2,Hua SHANG2,Guo TANG3,Ya-xin HAN4,Li LONG2,5,*()   

  1. 1. Department of Rheumatology and Immunology, Chengdu Second People's Hospital, Chengdu 610000, China
    2. Zunyi Medical University, Zunyi 563000, Guizhou, China
    3. Department of Rheumatology and Immunology, The Bishan Hospital of Chongqing, Chongqing 402760, China
    4. Department of Rheumatology and Immunology, The Wenjiang Hospital of Chengdu, Chengdu 610000, China
    5. Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, Chengdu 610000, China
  • Received:2020-07-30 Online:2023-08-18 Published:2023-08-03
  • Contact: Li LONG E-mail:llllyyyy2012@sina.com
  • Supported by:
    Chengdu Technology R&D Project of Benefiting People with Science and Technology(2015-HM01-00165-SF)

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摘要：

目的: 调查风湿病住院患者静脉血栓栓塞(venous thromboembolism，VTE)发生情况，探讨Padua预测评分是否适用于风湿病住院患者，并分析血清白蛋白是否与风湿病住院患者VTE发生相关。方法: 回顾性分析2018年9月至2019年9月四川省人民医院风湿免疫病住院患者资料，根据Padua预测评分进行VTE风险分层(≥4分为高危组，＜4分为低危组)，比较两组患者VTE发生情况及Padua预测评分与VTE事件的相关性。根据是否发生VTE事件分为VTE组及非VTE组，比较两组Padua预测评分差异，采用多因素Logistic回归模型分析Padua预测评分中的危险因素及血清白蛋白与VTE事件之间的关系。结果: 共1 547例风湿病住院患者纳入本研究，其中VTE 27例(1.7%)，包括下肢深静脉血栓19例(1.2%)、肺血栓栓塞症6例(0.4%)，肺血栓栓塞症合并下肢深静脉血栓2例(0.1%)。VTE组、非VTE组Padua预测评分分别为3.33±1.78和1.80±0.97(P＜0.05)，两组Padua预测评分≥4分的患者分别占37.0%(10/27)和4.3%(66/1 527)(P＜0.01)，VTE组平均血清白蛋白水平低于非VTE组[(29.79±6.36) g/L vs. (35.17±6.31) g/L，P＜0.01]。VTE高危组76例，低危组1 471例，两组VTE发生率分别为13.2%和1.2%(P＜0.001)。Logistic回归分析显示，激素治疗、近期创伤或手术、活动受限、年龄大于70岁及既往VTE病史为风湿病住院患者发生VTE的危险因素，OR值分别为7.11、7.07、3.40、2.40、2.00；血清白蛋白水平降低为风湿病住院患者发生VTE的危险因素(OR=0.88，P＜0.01)。结论: 风湿病住院患者VTE发生率较高，与VTE相关的危险因素有激素治疗、近期创伤或手术、活动受限、年龄大于70岁及既往VTE病史，其中激素治疗是最高级别的危险因素，且血清白蛋白水平降低也是风湿病住院患者发生VTE的危险因素。Padua预测评分虽然能在一定程度上反映风湿病住院患者VTE的发生风险，但效能有限，将来可对其进行优化，以便对风湿病住院患者进行更精准的VTE风险评估。

关键词: 静脉血栓栓塞, Padua预测评分, 风湿性疾病

Abstract:

Objective: To investigate the status of venous thromboembolism (VTE) in rheumatic inpatients, and to explore the efficiency of Padua prediction score (PPS) in the patient population. In addition, to analyze the relationship between serum albumin and VTE in rheumatic inpatients. Methods: Data of inpatients with rheumatology were retrospectively collected and analyzed at Sichuan Provincial People's Hospital from September 2018 to September 2019. Occurrence of VTE was compared between high (PPS≥4) and low (PPS < 4) risk groups. PPS were analyzed in the VTE and non-VTE patients. Multivariate Logistic regression model was used to analyze the risk factors in PPS and the relationship between serum albumin and VTE. Results: A total of 1 547 patients were included in this study, and 27 (1.7%) had symptomatic VTE. Among the symptomatic VTE cases, 19 (1.2%) had deep vein thrombosis (DVT) only, 6 (0.4%) had pulmonary thromboembolism (PTE) only, and 2 (0.1%) were diagnosed with DVT and PTE. PPS in the VTE and non-VTE groups were 3.33±1.78 and 1.80±0.97 respectively (P < 0.05).The number of patients with PPS≥4 in the VTE group and non-VTE group was 37.0% and 4.3% respectively (P < 0.01). The average serum albumin level in the VTE group was lower than that in non-VTE group [(29.79±6.36) g/L vs. (35.17±6.31) g/L, P < 0.001]. Seventy-six cases was divided into high-risk group of VTE, while 1 471 cases were in the low-risk group, and the incidence of VTE was 13.2% and 1.2% respectively (P < 0.001). Logistic regression analysis showed that ongoing hormonal treatment, age≥70 years, trauma and/or surgery ≤30 d, reduced mobility and previous VTE were risk factors of VTE in the rheumatology patients, OR values were 7.11, 7.07, 3.40, 2.40 and 2.00, respectively. Lower serum albumin level was the risk factor of VTE in the rheumatology patients [OR=0.88 (95%CI: 0.82-0.94)]. Conclusion: The incidence of VTE was relatively higher in the hospitalized patients in Department of Rheumatology and Immunology. Glucocorticoid therapy was the highest risk factor of VTE and lower serum albumin level also was the risk factor. Although the PPS can reflect the risk of VTE in rheumatic inpatients to some extent, its effectiveness is limited. PPS can be optimized for quantitative VTE risk assessment of rheumatic inpatients in the future.

Key words: Venous thromboembolism, Padua prediction score, Rheumatic diseases

中图分类号: 

  • R593.2

表1

Padua预测评分危险因素"

Component Score
Active cancer 3
Previous VTE 3
Reduced mobility 3
Known thrombophilic condition 3
Trauma/surgery < 30 d 2
Age≥70 years 1
Heart/respiratory failure 1
Acute MI or ischemic stroke 1
Acute infection/rehum disorder 1
Obesity (BMI≥30 kg/m2) 1
Ongoing hormonal treatment 1

表2

1 547例患者的疾病种类及分布"

Disease type n (%)
Rheumatoid arthritis 335 (21.7)
Primary Sjögren’s syndrome 249 (16.1)
Systemic lupus erythematosus 244 (15.8)
Osteoarthritis 195 (12.6)
Idiopathic inflammatory myositis 108 (7.0)
Spondyloarthritis 107 (6.9)
Gout 101 (6.5)
Overlap syndrome 84 (5.4)
Vasculitis 51 (3.3)
Systemic sclerosis 34 (2.2)
Adult Still’s disease 24 (1.6)
Panniculitis 15 (0.9)

表3

VTE组及非VTE组一般资料比较"

Items VTE group (n=27) Non-VTE group (n=1 520) P
Gender, n(%) 0.19
  Male 10 (37.0) 394 (25.9)
  Female 17 (63.0) 1 126 (74.1)
Age, n(%) 0.01
  ≥60 years 16 (59.3) 480 (31.6)
   < 60 years 11 (40.7) 1 041 (68.4)
Hypertension, n(%) 6 (13.9) 211 (16.0) 0.33
Diabetes, n(%) 3 (11.1) 91 (6.0) 0.48
BMI/(kg/m2), ${\bar x}$±s 23.24±4.56 22.50±3.46 0.15
Hospitalization days, ${\bar x}$±s 15.35±6.64 11.47±4.89 0.03
PPS, ${\bar x}$±s 3.33±1.78 1.80±0.97 < 0.001
Serum albumin/(g/L), ${\bar x}$±s 29.79±6.36 35.17±6.31 < 0.001

表4

PPS与VTE发生风险相关性的单因素二项Logistic回归分析"

PPS VTE (n=27), n (%) Non-VTE (n=1 520), n (%) OR (95%CI) P
0-1 2 (7.4) 580 (38.1) 1 (reference category)
2 11 (40.8) 718 (47.2) 4.43 (0.98, 20.12) 0.053
3 4 (14.8) 156 (10.3) 7.43 (1.35, 40.97) 0.021
4 2 (7.4) 32 (2.1) 18.12 (2.47, 132.86) 0.004
5 3 (11.1) 25 (1.7) 34.8 (5.56, 217.68) 0.001
≥6 5 (18.5) 9 (0.6) 161.11 (27.52, 943.07) 0.001

表5

PPS中危险因素的Logistic回归分析"

Risk factor OR(95%CI) P
Ongoing hormonal treatment 7.11 (2.13, 23.73) 0.001
Age≥70 years 2.40 (1.00, 5.76) 0.049
Trauma/surgery < 30 d 7.07 (1.55，32.24) 0.012
Reduced mobility 3.40 (2.37, 4.87) < 0.001
Previous VTE 2.00 (1.20, 3.33) 0.008

表6

血清白蛋白水平与VTE发生风险相关性的Logistic回归分析"

Serum albumin categories VTE (n=27) Non-VTE (n=1 520) OR (95%CI) P
Serum albumin ≥ 40.0 g/L 1 29 1 (reference category)
30.00 g/L ≤ Serum albumin < 40.00 g/L 15 77 6.05 (0.79, 45.98) 0.08
25.00 g/L ≤ Serum albumin < 30.00 g/L 6 179 11.89 (1.42, 99.59) 0.02
20.00 g/L ≤ Serum albumin < 25.00 g/L 3 880 13.83 (1.42, 134.77) 0.02
Serum albumin < 20.00 g/L 2 355 24.48 (2.16, 278.13) 0.01
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