摘要
目的比较2015年英国皇家妇产科医师学会(RCOG)《妊娠期及产褥期静脉血栓栓塞症(VTE)诊治指南》和2021年《中国妊娠期及产褥期VTE预防和诊治专家共识》的VTE风险评估模型对我国孕产妇罹患VTE的预测价值,为优化我国产科VTE防治策略提供依据。方法回顾性选取2018年1月至2022年6月于我院建档产检并分娩,且在妊娠期或产褥期发生VTE的孕产妇作为病例组(n=28),并选取同期建档产检并分娩且未发生VTE的孕产妇作为对照组(n=280)。采用受试者工作特征(ROC)曲线评价两种模型预测VTE的价值。结果本研究妊娠相关VTE患病率为0.49‰;两种评估模型的平均累积风险得分的比较结果均有统计学差异(t值分别为4.91、5.19,均P<0.05);RCOG指南及中国专家共识风险评估模型的曲线下面积(AUC)分别为0.783(95%CI:0.684~0.882)和0.794(95%CI:0.696~0.892);VTE组人群在妊娠期和产褥期阶段,RCOG指南及中国专家共识风险评估后的理论药物预防率比较后无显著性差异(P>0.05),对照组人群在妊娠期和产褥期阶段,遵循中国专家共识风险模型的药物预防率显著低于RCOG指南,差异有统计学意义(χ^(2)值分别为23.3、20.7,P<0.05)。结论本研究发现两种风险评估模型对孕产妇VTE均有一定的预测能力,中国专家共识风险评估模型的药物预防率低,药物预防成本低。
Objective To compare predictive value of two venous thromboembolism(VTE)risk assessment models(RAMs)—Guidelines for Diagnosis and Treatment of Venous Thromboembolism(VTE)during Pregnancy and Puerperal Period issued by Royal College of Obstetricians and Gynaecologists(RCOG)in 2015(in the following,called as RCOG guidelines RAM in brief)and Expert Consensus on Prevention,Diagnosis and Treatment of VTE during Pregnancy and Puerperal Period issued by Chinese Society of Obstetrics and Gynecology in 2021(in the following,called as Chinese expert consensus RAM in brief).Methods From January 2018 to June 2022,28 pregnant and puerperal women who registered,received prenatal examination and delivered in our hospital,and had VTE during pregnancy and puerperal period were selected as VTE group,and 280 pregnant and puerperal women who did not have VTE in the same period were selected as control group at a ratio of 1∶10.The risk of VTE was assessed by using the RCOG guidelines RAM and Chinese expert RAM respectively.Receiver operating characteristic(ROC)curve was used to analyze predictive values of the two risk assessment models for VTE in pregnant and puerperal women in China.Results A total of 28 hospitalized pregnant and puerperal women were diagnosed as pregnancy-related VTE,and total number of deliveries during the same period was 57401,the prevalence rate of VTE was 0.49‰.By the RCOG guidelines RAM,the average cumulative risk score in the VTE group was 3.3±2.0,and that in the control group was 1.4±1.4,there was a significant difference between the two groups(t=4.91,P<0.05).And by the Chinese expert consensus RAM,the average cumulative risk score in the VTE group was 2.5±1.6,and that in the control group was 0.9±1.0,there was a significant difference between the two groups(t=5.19,P<0.05).The areas under the curve(AUCs)of the two risk assessment models-the RCOG guidelines RAM and the Chinese expert consensus RAM were 0.783(95%CI:0.684-0.882,P<0.001)and 0.794(95%CI:0.696-0.892,P<0.001)respectively,there was no significant difference in AUC between the two assessment models(P=0.595).In the VTE group,both in pregnancy and puerperal period,there were no significant differences in theoretical pharmaceutical prophylaxis rate between the RCOG guidelines RAM and the Chinese expert consensus RAM(both P>0.05),while in the control group,the pharmaceutical prophylaxis rate by the Chinese expert consensus RAM was lower than that by the RCOG guidelines RAM both in pregnancy and puerperal period,and the differences were statistically significant(χ^(2)=23.3 and 20.7 respectively,both P<0.05).Conclusion The two RAMs both have certain prediction ability for maternal VTE.Compared to the RCOG guidelines RAM,the risk factors predicted by the Chinese expert consensus RAM for VTE during pregnancy and puerperal period are lesser,the pharmaceutical prophylaxis rate and the cost are significantly lower.It can be considered that the Chinese expert consensus RAM is more suitable for the population in China.
作者
危玲
张恩婕
何欣
祁少锷
陈奕
WEI Ling;ZHANG Enjie;HE Xin;QI Shaoe;CHEN Yi(Department of Obstetrics,The Affiliated Beijing Gynecological and Obstetric Hospital of Capital Medical University/Beijing Municipal Maternal and Child Health Hospital,Beijing 100026,China;Department of Central Laboratory,The Affiliated Beijing Gynecological and Obstetric Hospital of Capital Medical University/Beijing Municipal Maternal and Child Health Hospital,Beijing 100026,China;Department of Information,The Affiliated Beijing Gynecological and Obstetric Hospital of Capital Medical University/Beijing Municipal Maternal and Child Health Hospital,Beijing 100026,China)
出处
《中国妇幼健康研究》
2025年第8期23-30,共8页
Chinese Journal of Woman and Child Health Research
基金
国家自然科学基金(82304088)
首都特色临床应用研究(Z181100001718091)。
关键词
孕产妇
静脉血栓栓塞症
风险评估模型
预测
pregnant and puerperal women
venous thromboembolism
risk assessment model
prediction
