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中华临床实验室管理电子杂志 ›› 2021, Vol. 09 ›› Issue (01) : 12 -18. doi: 10.3877/cma.j.issn.2095-5820.2021.01.003

所属专题: 文献

实验研究

临床评分量表对预警院内深静脉血栓形成防治体系的临床价值
刘东婷1, 冯莹2,()   
  1. 1. 516000 广东惠州,惠州市中心人民医院
    2. 广东广州,广州医科大学附属第二医院
  • 收稿日期:2020-10-23 出版日期:2021-02-28
  • 通信作者: 冯莹

The clinical value of the clinical scoring scale in early warning system for prevention and treatment of deep venous thrombosis

Dongting Liu1, Ying Feng2,()   

  1. 1. Huizhou Municipal Central Hospital, Huizhou Guangdong 516000, China
    2. The Second Affiliated Hospital Of Guangzhou Medical University, Guangzhou Guangdong 510260, China
  • Received:2020-10-23 Published:2021-02-28
  • Corresponding author: Ying Feng
引用本文:

刘东婷, 冯莹. 临床评分量表对预警院内深静脉血栓形成防治体系的临床价值[J]. 中华临床实验室管理电子杂志, 2021, 09(01): 12-18.

Dongting Liu, Ying Feng. The clinical value of the clinical scoring scale in early warning system for prevention and treatment of deep venous thrombosis[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2021, 09(01): 12-18.

目的

比较改良Caprini评分量表与Autar评分量表对DVT的预警价值。

方法

以影像学为标准,对84例已确诊DVT患者进行回顾性分析,比较改良Caprini评分量表与Autar评分量表对院内DVT的预警价值,利用秩和检验了解两量表的实用性及高危识别效能,并应用两量表对5个临床科室的425例住院患者进行前瞻性研究,通过ROC曲线下面积(AUC)进行比较,了解两量表预测院内DVT的临床应用价值。

结果

1.回顾性分析中,通过秩和检验对Autar量表和改良Caprini量表两个量表进行统计,得出Z=-7.721,P=0.000<0.05,两者具有显著性差异。对组间进行比较,Autar量表及改良Caprini量表的有效率分别为33.3%(28/84) vs 92.9%(78/84),显示后者对预测DVT准确度更高。2.两量表中得分最高的高危因素相似,依次为卧床、高龄、恶性肿瘤、心脑血管疾病,提示具备以上高危因素的患者应高度关注VTE的发生。3.前瞻性分析425例住院患者两评分量表的结果,Autar量表与改良Caprini量表的AUC值分别为0.628和0.684,此外,Autar量表及改良Caprini量表无风险组或低风险组发生DVT分别占4.68%(11/235)及0%(0/63),提示改良Caprini量表预警DVT的效能更高。

结论

1.改良Caprini评分量表与Autar量表比较预警DVT的准确性更高,漏诊率更低,预警效能好;2.卧床、高龄、恶性肿瘤、心脑血管疾病是预测DVT意义较大的高危因素;3.两评分量表对早期识别VTE仍存在一定局限性,需结合临床表现动态评分和实验室监测进一步提高VTE的诊断效能。

Objective

Compare the diagnostic value of modified Caprini rating scale and Autar scale.

Methods

Using imaging as gold standard, 84 cases which have been confirmed in patients with DVT were analyzed retrospectively, and compared the values in the diagnosis of deep venous thrombosis by using Autar scale and modified Caprini scale. Also we used the practicability of using rank and inspection to understand high risk identification efficiency of the two scales. A prospective study was conducted on 425 patients from 5 clinical departments by using the two scales, and the clinical application value on predicting nosocomial DVT was compared by the area under the ROC curve.

Results

1. In the retrospective analysis, the statistics of Autar rating scale and the modified Caprini rating scale were conducted by rank sum test, Z=-7.721, P=0.000<0.05, which indicated significant differences between the two scales. The effective rates of the AUTOAR Autar scale and the modified Caprini scale were 33.3% (28/84) vs 92.9%(78/84), respectively, indicating that the latter had a higher accuracy in predicting DVT. 2. The highest scoring risk factors in the two score scales were similar, followed by bed rest, advanced age, malignant tumor, and cardiovascular and cerebrovascular disease, suggesting that patients with the above risk factors should be paid close attention to the occurrence of VTE. 3.In prospective analysis of the results of 425 patients with two scales, the AUC values of AUTOAR and the modified Caprini scale were 0.628 and 0.684, respectively. In addition, the incidence of DVT in the Autar and the modified Caprini scale was 4.68%(11/235) and 0%(0/63), respectively, suggesting that the improved Caprini scale had a higher warning effect on DVT.

Conclusions

1. Compared with the Autar scale, Modified Caprini scale showed higher accuracy and low missed diagnosis rate in early warning of DVT. 2. Bed rest, advanced age,, malignant tumor, and cardiovascular and cerebrovascular disease are significant risk factors for predicting DVT.3. The two scoring scales still have some limitations in the early identification of VTE, and the diagnostic efficiency of VTE should be further improved by combining clinical dynamic scoring and laboratory monitoring.

表1 Autar深静脉血栓栓塞症评分量表
表2 改良Caprini深静脉血栓栓塞症评分量表
表3 84例DVT患者分别应用两种评分量表的危险分层(n%)
图1 Autar量表各科室患者评分折线图
图2 改良Caprini量表各科室患者评分折线图
表4 425例DVT患者分别应用两种评分量表的危险分层(例;%)
表5 Autar量表、改良Caprini量表的ROC曲线下面积
图3 Autar量表、改良Caprini量表的ROC曲线
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