本文選題：糖尿病 + 靜脈血栓栓塞　； 參考：《中國(guó)全科醫(yī)學(xué)》2017年29期

【摘要】：目的探討Padua評(píng)分聯(lián)合D-二聚體對(duì)2型糖尿病內(nèi)科住院患者發(fā)生靜脈血栓栓塞癥(VTE)的診斷價(jià)值。方法收集中國(guó)人民解放軍第四七四醫(yī)院內(nèi)分泌科2013年1月—2016年3月臨床疑似VTE的2型糖尿病內(nèi)科住院患者305例,其中確診VTE組176例,未發(fā)生VTE組129例,回顧性分析兩組一般資料,并應(yīng)用受試者工作特征(ROC)曲線分析法比較Padua評(píng)分、D-二聚體水平及兩者聯(lián)合時(shí)對(duì)2型糖尿病內(nèi)科住院患者發(fā)生VTE的診斷價(jià)值。結(jié)果確診VTE組的年齡、糖化血紅蛋白水平、Padua評(píng)分、血漿D-二聚體水平均高于未發(fā)生VTE組,而三酰甘油水平低于未發(fā)生VTE組,確診VTE組的心腦血管疾病、急性感染、慢性肺部疾病、惡性腫瘤及既往VTE病史的發(fā)生率均高于未發(fā)生VTE組(P0.05)。Padua評(píng)分診斷2型糖尿病內(nèi)科住院患者VTE的最佳切點(diǎn)為4分,≥4分時(shí)靈敏度為53.41%,特異度為89.15%,約登指數(shù)為0.426,ROC曲線下面積為0.713[95%CI(0.655,0.771)];D-二聚體最佳切點(diǎn)為0.5 mg/L,≥0.5 mg/L時(shí)靈敏度為84.12%,特異度為51.94%,約登指數(shù)為0.361,ROC曲線下面積為0.683[95%CI(0.618,0.743)];Padua評(píng)分≥4分聯(lián)合D-二聚體≥0.5 mg/L時(shí)靈敏度為93.75%,特異度為51.94%,約登指數(shù)為0.457,ROC曲線下面積為0.801[95%CI(0.748,0.852)]。Padua評(píng)分聯(lián)合D-二聚體診斷2型糖尿病內(nèi)科住院患者發(fā)生VTE的ROC曲線下面積與單獨(dú)使用Padua評(píng)分或D-二聚體比較,差異均有統(tǒng)計(jì)學(xué)意義(Z=5.768,P0.001;Z=5.624,P0.001);而Padua評(píng)分與D-二聚體比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(Z=0.932,P0.05)。結(jié)論 Padua評(píng)分聯(lián)合D-二聚體診斷2型糖尿病內(nèi)科住院患者發(fā)生VTE是一種簡(jiǎn)單有效的風(fēng)險(xiǎn)診斷方法,有助于臨床醫(yī)師早期發(fā)現(xiàn)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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