Caprini评分联合血清学对妇科恶性肿瘤患者发生下肢深静脉血栓的预测价值

魏鑫源; 王才智; 王玲玲

doi:10.16766/j.cnki.issn.1674-4152.003908

Caprini评分联合血清学对妇科恶性肿瘤患者发生下肢深静脉血栓的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.003908

蚌埠医科大学第一附属医院妇产科，安徽蚌埠 233004

基金项目:

安徽高校自然科学研究项目 KJ2021A0754

详细信息

通讯作者:
王才智，E-mail: bbmcwcz@126.com

中图分类号: R737.3 R543.6
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- 文章访问数: 3
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出版历程
- 收稿日期: 2024-01-09
- 网络出版日期: 2025-05-14

Prediction value of Caprini score combined with serology for lower extremity deep vein thrombosis in patients with gynecological malignant tumor

Department of Obstetrics and Gynecology, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的回顾性分析妇科恶性肿瘤术后发生下肢深静脉血栓(DVT)患者的临床特征及血清学指标，探讨Caprini评分联合术前D-二聚体(D-D)、纤维蛋白原(FIB)对妇科恶性肿瘤患者术后发生下肢DVT的预测价值。方法选取2018年10月—2022年10月在蚌埠医科大学第一附属医院妇科及妇瘤科治疗的恶性肿瘤术后发生下肢DVT的95例患者作为血栓组，以1∶2比例纳入同期入院行手术治疗但未发生DVT的190例妇科恶性肿瘤患者作为非血栓组。比较2组患者的一般资料，分析Caprini评分与术前D-D、FIB的关系，探讨三者联合应用对妇科恶性肿瘤术后发生DVT的预测价值。结果血栓组术后Caprini评分与术前D-D、FIB呈正相关关系(r=0.375、0.426，均P＜0.05)。术后Caprini评分、术前D-D、FIB诊断DVT的AUC分别为0.832、0.811、0.782；最佳临界值分别为8.50分、0.54 mg/L、3.26 g/L；灵敏度分别为62.10%、76.80%、69.50%；特异度分别为90.50%、74.70%、77.90%；而术后Caprini评分与术前D-D、FIB联合应用诊断DVT的灵敏度为78.90%，特异度为79.50%，AUC为0.859(P＜0.05)。结论妇科恶性肿瘤患者术后Caprini评分与术前D-D、FIB呈正相关关系，当术后Caprini评分≥8.50分且术前D-D≥0.54 mg/L、FIB≥3.26 g/L时，应该高度怀疑DVT。
- 妇科恶性肿瘤 /
- 深静脉血栓 /
- Caprini评分 /
- D-二聚体 /
- 纤维蛋白原
Abstract: Objective The clinical characteristics and serological indexes of patients with lower extremity deep vein thrombosis (DVT) after surgery for gynecologic malignant tumor are retrospectively analyzed, and the predictive value of Caprini score combined with preoperative D-D and FIB for postoperative DVT in patients with gynecologic malignant tumor is discussed. Methods Ninety-five patients with postoperative DVT of lower limbs who were treated in the Department of Gynecology and Gynecologic Oncology of the First Affiliated Hospital of Bengbu Medical University from October 2018 to October 2022 were selected as the thrombus group, and 190 patients who were admitted for surgical treatment during the same period but did not develop DVT were included as the non-thrombotic group at a ratio of 1∶2. The general data of the two groups were compared, and the relationship between Caprini score and preoperative D-D, FIB was analyzed, and the predictive value of the combined application of the three on postoperative DVT of gynecological malignant tumor was discussed. Results Postoperative Caprini score was positively correlated with preoperative D-D and FIB in thrombus group (r=0.375, 0.426, both P < 0.05). The AUC of postoperative DVT in patients diagnosed with gynecological malignant tumor by Caprini score, D-D and FIB were 0.832, 0.811 and 0.782, respectively. The optimal critical values were 8.50 points, 0.54 mg/L and 3.26 g/L, respectively. The sensitivity were 62.10%, 76.80% and 69.50%, respectively. The specificity were 90.50%, 74.70% and 77.90%, respectively. The sensitivity and specificity of Caprini score combined with D-D and FIB in the diagnosis of postoperative DVT in patients with gynecological malignant tumor were 78.90%, 79.50% and 0.859 (P < 0.05). Conclusion In patients with gynecological malignant tumors, postoperative Caprini score is positively correlated with preoperative D-D and FIB. When postoperative Caprini score is ≥8.50 points, preoperative D-D is ≥0.54 mg/L and preoperative FIB is ≥3.26 g/L, DVT should be highly suspected.
- Gynecological malignant tumors /
- Deep vein thrombosis /
- Caprini score /
- D-dimer /
- Fibrinogen

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图 1 术后Caprini评分与术前D-D、FIB水平三者联合应用诊断妇科恶性肿瘤患者发生DVT的ROC曲线

Figure 1. ROC curve of postoperative Caprini score combined with preoperative D-D and FIB levels in the diagnosis of DVT in patients with gynecological malignancies

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表 1 2组妇科恶性肿瘤患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with gynecological malignancies

组别	例数	年龄(x±s，岁)	BMI (x±s)	手术时间(x±s, min)	手术方式[例(%)]		肿瘤类型[例(%)]
组别	例数	年龄(x±s，岁)	BMI (x±s)	手术时间(x±s, min)	开腹	腔镜	宫颈癌	卵巢癌	内膜癌
血栓组	95	59.32±9.05	24.36±2.94	201.15±66.40	79(83.16)	16(16.84)	27(28.42)	35(36.84)	33(34.74)
非血栓组	190	55.16±8.99	23.63±2.10	184.18±49.17	150(78.95)	40(21.05)	55(28.95)	64(33.68)	71(37.37)
统计量		3.674^a	2.169^a	2.206^a	0.711^b		0.308^b
P值		＜0.001	0.032	0.029	0.399		0.857

组别	例数	有无输血[例(%)]		高血压病史[例(%)]		糖尿病病史[例(%)]		心脏病病史[例(%)]
组别	例数	有	无	有	无	有	无	有	无
血栓组	95	26(27.37)	69(72.63)	27(28.42)	68(71.58)	9(9.47)	86(90.53)	6(6.32)	89(93.68)
非血栓组	190	32(16.84)	158(83.16)	61(32.11)	129(67.89)	27(14.21)	163(85.79)	18(9.47)	172(90.53)
统计量		4.329^b		0.403^b		1.288^b		0.819^b
P值		0.037		0.526		0.256		0.365
注：^a为t值，^b为χ²值。

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表 2 2组妇科恶性肿瘤患者的实验室指标比较

Table 2. Comparison of laboratory indexes between the two groups of patients with gynecological malignancies

组别	例数	HB (x±s, g/L)	D-D [M(P₂₅, P₇₅), mg/L]	FIB [M(P₂₅, P₇₅), g/L]	TT (x±s, s)	PTA (x±s, %)	PT (x±s, s)
血栓组	95	116.42±16.59	1.13(0.54, 2.38)	3.74(2.93, 4.65)	17.99±1.77	113.17±13.81	10.89±0.88
非血栓组	190	121.02±14.57	0.37(0.25, 0.54)	2.53(2.06, 3.21)	18.07±1.09	113.06±11.51	10.92±0.66
统计量		2.397^a	-8.553^b	-7.752^b	0.433^a	0.071^a	0.259^a
P值		0.017	＜0.001	＜0.001	0.666	0.994	0.795

组别	例数	APTT (x±s, s)	PLT (x±s, 10⁹/L)	ALB [M(P₂₅, P₇₅), g/L]	NEU (x±s, 10⁹/L)	LY [M(P₂₅, P₇₅), 10⁹/L]
血栓组	95	24.98±2.09	279.98±81.51	39.80(35.80, 41.80)	3.74±1.68	1.66(1.28, 2.04)
非血栓组	190	24.98±1.99	255.38±74.69	41.70(39.18, 43.50)	3.62±1.15	1.69(1.42, 1.97)
统计量		0.014^a	2.542^a	-4.874^b	0.654^a	-0.207^b
P值		0.988	0.012	＜0.001	0.514	0.836
注：^a为t值，^b为Z值。

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表 3 2组妇科恶性肿瘤患者Caprini评分比较(x ±s，分)

Table 3. Comparison of Caprini scores between the two groups of patients with gynecological malignant tumors (x ±s, points)

组别	例数	术前	术后	t值	P值
血栓组	95	4.23±1.00	9.11±1.83	22.808	＜0.001
非血栓组	190	4.05±0.67	6.89±1.17	29.035	＜0.001
统计量		1.585^a	77.717^b
P值		0.115	＜0.001
注：^a为t值，^b为F值。

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表 4 血栓组妇科恶性肿瘤患者术后Caprini评分与术前D-D、FIB的相关性

Table 4. Correlation between postoperative Caprini and preoperative D-D and FIB in patients with gynecological malignancies in the thrombosis group

项目	r值	P值
D-D	0.375	＜0.001
FIB	0.426	＜0.001

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表 5 术后Caprini评分与各指标相关性分析

Table 5. Correlation analysis between Caprini score and various indexes after surgery

项目	临界值	灵敏度(%)	特异度(%)	约登指数	AUC
D-D	0.54 mg/L	76.80	74.70	0.515	0.811
FIB	3.26 g/L	69.50	77.90	0.474	0.782
术后Caprini评分	8.50分	62.10	90.50	0.526	0.832
术后Caprini评分+D-D+FIB		78.90	79.50	0.584	0.859

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