老年肺癌患者静脉血栓栓塞症风险预测工具的比较研究

doi:10.3761/j.issn.0254-1769.2023.019.004

摘要/Abstract

摘要：

目的比较4种静脉血栓栓塞症（venous thromboembolism，VTE）风险评估工具对老年肺癌患者发生VTE的预测效能。方法连续选择2020年1月—2022年6月，北京市某三级甲等医院呼吸与危重症医学科住院的老年肺癌患者，采用Caprini评分、Padua评分、Khorana评分和COMPASS-CAT评分4种风险评估工具进行血栓风险评估，并随访至入组后第6个月。根据各评分对应截断值将患者分为低中危组和高危组，比较两组之间发生VTE的差异。利用受试者工作特征曲线下面积评价4种VTE预测工具对老年肺癌患者远期发生VTE的预测效能。结果纳入111例老年肺癌患者，入组后6个月内，20例（18.0%）发生VTE。VTE组和未发生VTE组D-二聚体的比较，差异有统计学意义（P<0.05）。Caprini评分高危组VTE发生率显著高于中危组，差异有统计学意义（P=0.022），Padua评分高危组VTE发生率显著高于低危组，差异有统计学意义（P<0.001），而Khorana和COMPASS-CAT评分高危组VTE发生率均高于非高危组，但差异无统计学意义（均P>0.05）。Padua评分、Caprini评分、Khorana评分和COMPASS-CAT评分对应的受试者工作特征曲线下面积依次为0.805（95%CI：0.672~0.937）、0.757（95%CI：0.643~0.871）、0.552（95%CI：0.401~0.704）和0.515（95%CI：0.356~0.673）。结论老年肺癌患者VTE发生率高，亟须通过风险预测工具早期发现高危人群。Padua评分系统对老年肺癌患者VTE风险的预测效能优于Caprini评分、Khorana评分和COMPASS-CAT评分。

关键词: 老年人, 肺癌, 静脉血栓栓塞症, 风险评估, 护理

Abstract:

Objective To compare the predictive performance of 4 risk assessment models for venous thromboembolism（VTE） in elderly patients with lung cancer. Methods We prospectively and consecutively recruited lung cancer patients aged ≥60 years who were admitted to the Department of Respiratory and Critical Care Medicine of Beijing Hospital between January 2020 and June 2022，and followed up them for VTE within 6 months after enrollment. Caprini score，Padua score，Khorana score and COMPASS-CAT score were used to evaluate the risk of VTE of each patient，and then they were divided into a low-medium risk group or a high-risk group based on the cut-off value of each score. We compared the rates of VTE in the follow-up period between both groups. The area under receiver operative characteristic（AUC） was used to evaluate the predictive performance of the 4 models for long-term VTE in elderly patients with lung cancer. Results A total of 111 elderly patients with lung cancer were enrolled. The mean（±SD） age was（70.9±7.1） years；31（27.9%） were women；92（82.9%） were patients with non-small cell lung cancer. 20（18.0%）patients developed VTE within 6 months after enrollment. There were no significant differences in age，gender，BMI and comorbidity between the VTE group and the non-VTE group. The incidence of VTE in high-risk group assessed by Caprini score was significantly higher than that in medium-risk group. The incidence of VTE in high-risk group assessed by Padua score was significantly higher than that in low-risk group. However，the incidences of VTE in high-risk group assessed by Khorana and COMPASS-CAT scores were numerically higher than that in the corresponding comparative group（all P>0.05）. The AUC for VTE in Padua score，Caprini score，Khorana score and COMPASS-CAT score were 0.805（95% CI：0.672~0.937），0.757（95% CI：0.643~0.871），0.552（95%CI：0.401~0.704），and 0.515（95%CI：0.356~0.673），respectively. Conclusion Elderly patients with lung cancer had a high incidence of long-term VTE，and a risk predictive model is urgently needed to identify high-risk patients. Compared with Caprini score，Khorana score，and COMPASS-CAT score，Padua score showed a better ability in predicting the risk of VTE among elderly patients with lung cancer.

Key words: Aged, Lung Cancer, Venous Thromboembolism, Risk Assessment, Nursing Care

梅茵, 黄立学, 刘晔, 陈伟. 老年肺癌患者静脉血栓栓塞症风险预测工具的比较研究[J]. 中华护理杂志, 2023, 58(19): 2333-2338.

MEI Yin, HUANG Lixue, LIU Ye, CHEN Wei. A comparative study of risk prediction models for venous thromboembolism in elderly patients with lung cancer[J]. Chinese Journal of Nursing, 2023, 58(19): 2333-2338.

图/表 3

表1 患者一般资料的比较

Table 1 >Baseline data of all patients

表2 不同危险分层的患者发生静脉血栓栓塞症的比较（n=111）

Table 1 Comparison of the number of patients with different scores and VTE events in each risk assessment model（n=111）

图1 不同风险预测工具预测老年肺癌患者静脉血栓栓塞症的受试者工作特征曲线

Figure 1 Receiver operating characteristic curve of each risk assessment model predicting venous thromboembolism in elderly patients with lung cancer

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