| 郭意男,何飞,王振,叶杨.结核病患者并发静脉血栓栓塞症的风险因素分析[J].浙江中西医结合杂志,2021,31(12): |
| 结核病患者并发静脉血栓栓塞症的风险因素分析 |
| Analysis of influencing factors in tuberculosis patients with VTE |
| 投稿时间：2021-02-24 修订日期：2021-11-24 |
| DOI： |
| 中文关键词: 结核 结核病 静脉血栓栓塞症 因素分析 |
| 英文关键词:Tuberculosis, Venous thromboembolism(VTE), Factor analysis |
| 基金项目:杭州市红十字会医院青年基金项目 |
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| 中文摘要: |
| 目的 探讨分析结核病患者并发VTE的风险因素。 方法 参照结核病诊断标准纳入2016年1月1日至2020年1月1日在杭州市红十字会医院收治的11267例患者，并筛选合并VTE患者107例入VTE组，按照VTE组与对照组1:1的比例随机筛选对照组患者,通过单因素和多因素logistic回归分析评估结核病患者各种指标及因素与并发VTE的关联 结果 214例患者中，男性145例（60.17%），女性69例（32.2%），平均年龄62.21±19.35岁，结核病患者并发VTE的发生率为0.95%，单因素组间比较显示年龄、发热、气促、下肢水肿、呼吸衰竭、恶性肿瘤、PT、APTT、D-二聚体、血红蛋白存在差异，且P＜0.05。多因素logistic回归分析显示，二聚体数值越高、下肢水肿的高发生率及结核的活动是患者发生VTE的危险因素[OR（95%CI）=8.840（2.383-32.794）；OR（95%CI）=4.957（1.219-20.161）；OR（95%CI）=16.216（4.779-55.025）]；利福霉素类药物的使用是患者发生VTE的保护因素[OR（95%CI）=0.170(0.073-0.395)]。D-二聚体ROC曲线[AUC=0.831±0.028（95%CI：0.776~0.886，P＜0.05）],根据约登指数得出截值为1855ug/L,此时敏感度为82.2%、特异度为74.3%。结论 结核病患者合并VTE发生率较高，应积极规范预防及诊疗。当结核病患者发热、气促下肢水肿与D-二聚体＞1855ug/L时，应积极排查VTE的可能，必要时可予以预防性抗凝治疗。有效的抗结核治疗有助于降低结核病患者并发VTE概率。 |
| 英文摘要: |
| Objective To explore influencing factors in tuberculosis patients with VTE. Method According to the diagnostic criteria, 11267 tuberculosis patients from Zhejiang Integrated Traditional and Western Medicine Hospital from January 1 2016 to January 1 2020 were included. 107 tuberculosis patients with VTE were selected for VTE group. Patients in the control group were randomly screened according to the ratio of 1:1 between the VTE group and the control group. Univariate analysis and multivariate logistic regression analysis were used to evaluate the association of indicators and factors in tuberculosis patients with VTE. Results Of the 214 patients, 145(60.17%) were male, 69(32.2%) were female, with an average age of 62.21±19.35, the incidence of tuberculosis patients with VTE is 0.95%.By univariate analysis, it was found that age, fever, shortness of breath, lower limb edema, respiratory failure, malignant tumor, PT, APTT, D – dimer and hemoglobin had difference between two group( P < 0.05).By multivariate logistic regression analysis,it showed that higher dimer value, higher incidence of lower limb edema and tuberculosis activity were risk factors for VTE [OR (95%CI) =8.840 (2.383-32.794); OR (95%CI) =4.957 (1.219-20.161); OR (95%CI) =16.216 (4.779-55.025)].The use of rifamycin was a protective factor for VTE [OR (95%CI) =0.170(0.073-0.395)].ROC curve of D-dimer [AUC=0.831±0.028 (95%CI: 0.776~0.886, P < 0.05)], the cut-off value of 1855ug/L was obtained according to Youden index, and the sensitivity was 82.2% and the specificity was 74.3%. Conclusion Tuberculosis patients had high risk with VTE, need normative and active prevention and treatment. When tuberculosis patients have fever, shortness of breath, lower extremity edema and D-dimer > 1855ug/L, the possibility of VTE should be actively screened, and prophylactic anticoagulant therapy can be given if necessary. Effective anti-tuberculosis therapy is helpful to reduce the probability of VTE in tuberculosis patients. |
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