2020 年第 7 期 第 15 卷

下肢静脉血栓患者Wells评分及相关危险因素分析

Analysis of Wells score and risk factors in patients with venous thrombosis of lower extremity

作者：郗萌1罗丹1周蓉1蒋文慧2任延平1

英文作者：Xi Meng1 Luo Dan1 Zhou Rong1 Jiang Wenhui2 Ren Yanping1

单位：1西安交通大学第一附属医院老年内一科710062；2西安交通大学医学部护理系710049

英文单位：1The First Department of Geriatrics the First Affiliated Hospital of Xi′an Jiaotong University Xi′an 710062 China； 2Department of Nursing Xi′an Jiaotong University Health Science Center Xi′an 710049 China

关键词：下肢静脉血栓；Wells评分；肺血栓栓塞症

英文关键词：VenousthrombosisofLowerextremity；Wellsscore；Pulmonarythromboembolism

• 摘要：

• 目的评价Wells评分在住院下肢静脉血栓患者中预测肺血栓栓塞症(PTE)的效能，并分析Wells评分低风险人群发生下肢深静脉血栓的危险因素。方法回顾性分析2018年1—12月于西安交通大学第一附属医院住院并发生下肢静脉血栓的患者1 202例。按照Wells评分将患者分为低风险组(Wells评分0分，386例)和中高风险组(Wells评分≥1分，816例)，比较Wells评分不同风险患者、不同下肢静脉血栓类型低风险患者临床资料的差异，分析低风险患者发生下肢深静脉血栓的危险因素。结果低风险组下肢深静脉血栓患病率低于中高风险组［26.4%(102/386)比35.3%(288/816)］(P=0.002)，但PTE患病率高于中高风险组［6.0%(23/386)比3.4%(28/816)］(P=0.042)。将Wells评分低风险人群按照不同血栓类型分为下肢肌间静脉血栓组(284例)和下肢深静脉血栓组(102例)。下肢深静脉血栓组男性、既往静脉曲张病史、既往静脉血栓栓塞(VTE)病史、血液净化治疗比例及降钙素原水平均高于下肢肌间静脉血栓组，年龄低于下肢肌间静脉血栓组，差异均有统计学意义(均P＜0.05)。Logistic回归分析结果显示，既往VTE病史、既往静脉曲张病史、血液净化治疗是Wells评分低风险人群发生下肢深静脉血栓的危险因素(均P＜0.05)。结论Wells评分对住院下肢静脉血栓患者PTE发生风险的预测效能欠佳。即使对于低风险的患者，当伴随有既往VTE病史、既往静脉曲张病史、血液净化治疗等危险因素时，也不能单独依赖Wells评分排除发生下肢深静脉血栓的可能。

• ObjectiveTo evaluate the efficacy of Wells score in predicting pulmonary thrombo embolism(PTE) in patients with venous thrombosis of lower extremity, and to analyze the risk factors of deep venous thrombosis（DVT） in low-risk populations with Wells score. Methods From January to December 2018, 1 202 inpatients with venous thrombosis of lower extremity admitted to the First Affiliated Hospital of Xi′an Jiaotong University were analyzed retrospectively. According to Wells score, the patients were divided into low-risk group (Wells score 0, 386 cases) and medium high-risk group (Wells score≥1, 816 cases). The differences of Wells score and types of venous thrombosis of lower extremity were compared； the risk factors of DVT were analyzed. Results  The prevalence of DVT in low-risk group was lower than that in medium high-risk group ［26.4%(102/386) vs 35.3%(288/816), P=0.002］, but the prevalence of PTE was higher than that in medium high-risk group ［6.0%(23/386) vs 3.4%(28/816)，P=0.042］. According to different types of thrombus, the low-risk patients with Wells score were divided into intramuscular venous thrombosis of lower extremity group (284 cases) and DVT group (102 cases). The male, venous thromboembolism(VTE) history, varicosity history and the proportion of blood purification treatment in DVT group were higher than those in intramuscular venous thrombosis of lower extremity group； the age was younger than that in intramuscular venous thrombosis of lower extremity group (allP＜0.05). Logistic regression analysis showed that the previous history of VTE, the history of previous varicose veins, and blood purification treatment were the risk factors for the development of lower limb DVT in low-risk populations (all P＜0.05). Conclusions  Wells score is not effective in predicting the risk of PTE in hospitalized patients with venous thrombosis of lower extremity. The Wells score cannot be used alone to rule out the possibility of deep vein thrombosis of the lower extremities in low-risk patients with previous risk factors such as a history of VTE, a history of varicose veins, and blood purification.