比較不同VTE風(fēng)險(xiǎn)評分模型對糖尿病患者VTE的預(yù)測價(jià)值
發(fā)布時(shí)間：2018-07-17 15:49
【摘要】：目的:(1)探討Pauda評分、修正的Geneva評分、Caprini評分和Wells PE評分對內(nèi)科住院的2型糖尿病患者肺血栓栓塞癥(PTE)的預(yù)測價(jià)值;(2)探討Pauda評分、修正的Geneva評分、Caprini評分和Wells DVT評分對內(nèi)科住院的2型糖尿病患者深靜脈血栓形成(DVT)的預(yù)測價(jià)值。方法:(1)回顧性收集解放軍第474醫(yī)院2013年1月至2016年4月進(jìn)行CT肺動脈造影(computed tomographic pulmonary angiography,CTPA)的臨床疑診肺血栓栓塞癥的2型糖尿病內(nèi)科住院患者病例資料。最終收集了167例疑診PTE的2型糖尿病內(nèi)科住院患者的病例資料。使用Padua評分、修正的Geneva評分、Caprini評分、Wells PE評分方法對患者進(jìn)行評分。以上述4種評分評估的分值為結(jié)果變量,以CTPA確診肺栓塞結(jié)果為狀態(tài)變量,繪制ROC曲線。ROC曲線下面積及約登指數(shù)越大說明預(yù)測價(jià)值越高。(2)回顧性收集解放軍第474醫(yī)院2013年1月至2016年6月疑診DVT且合并2型糖尿病的內(nèi)科住院患者病例資料,所有入選患者均進(jìn)行四肢及腹部大血管彩超檢查。最終收集了378例疑診DVT的2型糖尿病內(nèi)科住院患者的病例資料。使用Padua評分、修正的Geneva評分、Caprini評分、Wells DVT評分方法對患者進(jìn)行評分。以上述4種評分評估的分值為結(jié)果變量,以確診DVT結(jié)果為狀態(tài)變量,繪制ROC曲線。ROC曲線下面積及約登指數(shù)越大說明預(yù)測價(jià)值越高。結(jié)果:(1)167例臨床疑診PTE的2型糖尿病內(nèi)科住院患者中,男77例、女97例,平均年齡(69.2±9.30)歲。最終確診為肺血栓栓塞癥患者83例,確診率為49.7%(83/167),PTE組和非PTE組比較,年齡、心率、腫瘤、臥床、既往VTE病史、心衰、呼衰、單側(cè)下肢深靜脈觸痛伴下肢水腫、急性心肌梗塞、正在接受激素治療、急性感染有統(tǒng)計(jì)學(xué)差異(P0.05)。Padua評分、修正的Geneva評分、Caprini評分、Wells PE評分診斷2型糖尿病內(nèi)科住院患者合并PTE的ROC曲線下面積分別為0.797±0.034、0.651±0.042、0.724±0.039、0.726±0.039,靈敏度分別為56.63%、89.16%、49.4%、78.31%,特異度分別為94.05%、36.9%、88.1%、63.1%,約登指數(shù)分別為0.51、0.26、0.37、0.41,最佳分界值分別為4分、3分、6分、1分。上述四種評分ROC曲線下面積比較結(jié)果如下:修正Geneva評分與Padua評分比較差異有統(tǒng)計(jì)學(xué)意義(P0.0083),Padua評分與Caprini評分、Wells PE評分比較差異無統(tǒng)計(jì)學(xué)意義(P0.0083),修正的Geneva評分與Caprini評分、Wells PE評分比較差異無統(tǒng)計(jì)學(xué)意義(P0.0083),Padua評分與Wells PE評分比較差異無統(tǒng)計(jì)學(xué)意義(P0.0083)。(2)378例疑診DVT的2型糖尿病內(nèi)科住院患者中,男199例、女179例,平均年齡(65.9±12)歲,最終確診DVT患者95例,確診率25.1%(95/378),95例DVT患者中,年齡大于40歲者93例,占97.7%,D-二聚體陽性者90例,占94.7%,心率大于或等于75次/分81例,占85.3%,單側(cè)下肢疼痛80例,占84.2%,單側(cè)下肢深靜脈觸痛伴水腫78例,占82.1%,急性感染74例,占77.9%,體重指數(shù)大于25kg/m2 48例,占50.5%;Padua評分、修正的Geneva評分、Caprini評分、Wells DVT評分診斷2型糖尿病內(nèi)科住院患者合并DVT的ROC曲線下面積分別為0.795±0.022、0.884±0.0237、0.623±0.0303、0.854±0.022,靈敏度分別為85.26%、80.00%、72.63%、82.11%,特異度分別為70.67%、90.11、49.47%、81.63%,約登指數(shù)分別為0.56、0.70、0.22、0.64,最佳分界值分別為2分、7分、3分、1分;四種評分ROC曲線下面積兩兩比較:Padua評分與Wells DVT評分比較差異無統(tǒng)計(jì)學(xué)意義(P0.0083),Padua評分與Caprini評分、修正的Geneva評分比較差異有統(tǒng)計(jì)學(xué)意義(P0.0083),Caprini評分與修正的Geneva評分、Wells DVT評分比較差異有統(tǒng)計(jì)學(xué)意義(P0.0083),修正的Geneva評分與Wells DVT評分比較差異無統(tǒng)計(jì)學(xué)意義(P0.0083)。結(jié)論:(1)Padua評分、修正的Geneva評分、Caprini評分和Wells PE評分在一定程度上均可預(yù)測2型糖尿病內(nèi)科住院患者肺血栓栓塞癥的發(fā)生風(fēng)險(xiǎn)。Padua評分預(yù)測價(jià)值最高,修正的Geneva評分預(yù)測價(jià)值最小,Wells PE評分、Caprini評分預(yù)測價(jià)值稍低于Padua評分,但四種評分預(yù)測價(jià)值有限,均未達(dá)優(yōu)秀。(2)Padua評分、修正的Geneva評分、Caprini評分和Wells DVT評分均能在一定程度上預(yù)測2型糖尿病內(nèi)科住院患者DVT的發(fā)生風(fēng)險(xiǎn)。四種評分預(yù)測價(jià)值由大到小分別為修正的Geneva評分Wells DVT評分Padua評分Caprini評分,修正的Geneva評分預(yù)測價(jià)值最高,可達(dá)優(yōu)秀。Wells DVT評分略高于Padua評分,但兩者比較無統(tǒng)計(jì)學(xué)差異,預(yù)測價(jià)值相當(dāng),均可達(dá)中等以上,Caprini評分預(yù)測價(jià)值較差。
[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.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.5;R587.1
本文編號：2130151
[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.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.5;R587.1
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