汪澄,陈霞,查鑫蒙,等.基于Caprini风险评估模型的脊髓损伤后下肢深静脉血栓形成风险的预测效应研究[J].中华物理医学与康复杂志,2025,47(4):331-336
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| 基于Caprini风险评估模型的脊髓损伤后下肢深静脉血栓形成风险的预测效应研究 |
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| DOI：10.3760/cma.j.cn421666-20220406-00334 |
| 中文关键词: 脊髓损伤 深静脉血栓 Caprini风险评估模型 预测效应 |
| 英文关键词: Spinal cord injury Deep vein thrombosis Caprini risk assessment |
| 基金项目:中国科学技术大学校级本科质量工程项目（2021xjyxm123） |
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| 中文摘要: |
| 目的 基于Caprini风险评估模型（Caprini RAM）分析脊髓损伤(SCI)患者下肢深静脉血栓（DVT)相关危险因素对DVT的预测效应。 方法 回顾性分析2017年1月至2021年12月在中国科学技术大学附属第一医院（安徽省立医院）康复医学科就诊的SCI患者576例，其中符合纳入标准有501（86.98%）例，根据Caprini评分将501例患者分为3组，0～1分为低危组（130例），2分为中危组（43例），≥3分为高危组（328例）。收集的信息包括：入院时性别、年龄、损伤原因、损伤部位、美国脊髓损伤协会分级（ASIA分级）、吸烟史、是否手术、是否并发肺部感染及尿路感染、是否保留导尿、是否合并2型糖尿病及高血压病、凝血功能（D-二聚体水平、纤维蛋白原水平、凝血酶原时间、活化部分凝血酶原时间及国际标准化比值）和血常规（红细胞数、白细胞数、血小板数及中性粒细胞百分比）、Caprini评分以及下肢B超结果（是否形成DVT）。将Caprini评分分别作为分类变量和连续变量，与其它危险因素一起与DVT的发生率进行多因素逻辑回归分析，应用广义相加模型进行曲线拟合和阈值饱和效应分析，并应用对数似然比检验进行线性关系检验，以了解Caprini评分与DVT发生率的关系。 结果 将Caprini评分作为分类变量，结果发现，Caprini评分（高危组）（OR=7.264）、年龄（OR=1.050）、D-二聚体水平（OR=1.113）、凝血酶原时间（OR=1.494）、血小板数（OR=1.004）和肺部感染（OR=1.83）是DVT发生率的独立危险因素(P<0.05)，红细胞数是DVT发生率的保护因素（OR=0.509，P<0.05。将Caprini评分作为连续性变量，结果发现，Caprini评分（OR=1.132）、年龄（OR=1.054）、D-二聚体水平（OR=1.103）、凝血酶原时间（OR=1.529）和血小板数（OR=1.003）仍然是DVT形成风险的独立危险因素(P<0.05)，红细胞数（OR=0.541）仍是DVT形成风险的保护因素（OR<1，P<0.05）。调整其他危险因素和保护因素后，Caprini评分与DVT发生率呈现曲线递增关系（P<0.05），折点为3分（P<0.05）。当Caprini评分<3分时，Caprini评分每增加1分，DVT发生风险增加1.83倍（OR=1.83，P<0.05）；Caprini评分>3分时，Caprini评分每增加1分，DVT发生风险增加1.06倍（OR=1.06，P<0.05）。 结论 调整独立危险因素（年龄、D-二聚体、凝血酶原时间、血小板计数）及保护因素（红细胞计数）后，Caprini评分与DVT风险呈曲线递增关系，临床上需重点关注Caprini评分≥3分的SCI患者。 |
| 英文摘要: |
| Objective To evaluate the Caprini risk assessment model (Caprini RAM) for predicting lower extremity deep vein thrombosis (DVT) after a spinal cord injury (SCI). Methods Five hundred and one SCI patients were divided into low- (0-1 points, n=130), medium- (2 points, n=43), and high-risk (≥3 points, n=328) groups according to their Caprini scores. The data covering all 501 included gender, age, cause of injury, injury site, American Spinal Injury Association classification, smoking history, surgical history, concurrent pulmonary or urinary tract infections, indwelling catheterization, comorbid type 2 diabetes or hypertension, D-dimer level, fibrinogen level, prothrombin time (PT), activated partial thromboplastin time, international normalized ratio), red blood cell (RBC) count, white blood cell count, platelet (PLT) count and neutrophil percentage. DVTs were detected using lower extremity ultrasound. The Caprini scores were treated as both categorical and continuous variables alongside the other risk factors in multivariate logistic regressions predicting DVT incidence. Generalized additive models were used for curve fitting and threshold saturation analysis, and log-likelihood ratio tests were applied to evaluate the linear relationships observed between Caprini scores and DVT incidence. Results When the Caprini score was used as a categorical variable, a high risk score (OR=7.264), age (OR=1.050), D-dimer (OR=1.11) , PT (OR=1.494), PLT count (OR=1.004) and lung infection (OR=1.83) were found to be significant independent predictors of DVT. RBC was a protective factor (OR=0.509). When the Caprini score was used as a continuous variable, lung infection lost its predictive utility. After adjusting for the risk and protective factors, the Caprini scores and the incidence of DVT showed a significant curvilinear increasing association, with a breakpoint of 3. When the Caprini score was less than 3, the incidence of DVT increased 1.83 times with a 1 point increase in the Caprini score. Beyond 3 the multiplier was 1.06. Conclusions With the independent risk factors accounted for, Caprini scores demonstrate a curvilinear increasing relationship with DVT risk. Clinically, special attention should be given to SCI patients with Caprini scores ≥3. |
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