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摘要:
目的 分析脑卒中并发静脉血栓栓塞症的发生情况及危险因素。 方法 选取2018年1月–2021年6月在我院接受治疗的2709例脑卒中患者。统计脑卒中并发静脉血栓栓塞症的发生情况，采用logistic回归分析影响脑卒中并发静脉血栓栓塞症的危险因素。 结果 2709例脑卒中患者中有390例发生静脉血栓栓塞症，静脉血栓栓塞症的发生率为14.39%，其中深静脉血栓形成（deep venous thrombosis, DVT）383例（14.14%），肺血栓栓塞症（pulmonary thromboembolism, PTE）4例（0.15%），DVT合并PTE 3例（0.11%）。非条件多因素logistic回归模型分析结果显示，年龄>60岁、合并高血压、合并糖尿病、入院后卧床时间≥3 d、D-二聚体（D-dimer, D-D）≥0.95 mg/mL、三酰甘油（triglyceride, TG）≥1.83 mmol/L、BI评分≤9分、Padua评分>4分是脑卒中并发静脉血栓栓塞症的独立危险因素（P<0.05），进行抗凝治疗为保护性因素（P<0.05）。 结论 脑卒中并发静脉血栓栓塞症与年龄、合并高血压、合并糖尿病、卧床时间、D-D、TG、BI评分、Padua评分及有无抗凝治疗存在一定关联，应加强符合相关危险因素的干预以有效降低脑卒中并发静脉血栓栓塞症的风险。 Abstract:Objective To investigate the occurrence and the risk factors of stroke complicated by venous thromboembolism. Methods A total of 2709 stroke patients who received treatment at our hospital between January 2018 and June 2021 were selected. The incidence of stroke complicated by venous thromboembolism was analyzed and the risk factors of stroke complicated by venous thromboembolism were investigated by logistic regression. Results Among the 2709 stroke patients, 390 had venous thromboembolism, resulting in 14.39% incidence of venous thromboembolism. Among them, 383 patients (14.14%) had deep venous thrombosis (DVT), 4 patients (0.15%) had pulmonary thromboembolism (PTE), and 3 cases (0.11%) had DVT combined with PTE. According to the analysis of unconditional multivariate logistic regression model, age>60 years, concomitant hypertension, concomitant diabetes, bedrest time after admission≥3 days, D-dimer (D-D)≥0.95 mg/mL, triglyceride (TG)≥1.83 mmol/L, Barthel Index (BI) score≤9 points, and Padua score>4 points after admission were independent risk factors for stroke complicated by venous thromboembolism (P<0.05), while anticoagulation therapy was a protective factor (P<0.05). Conclusion Stroke complicated by venous thromboembolism is associated, to some degree, with age, concomitant hypertension, concomitant diabetes, bedrest time, D-D, TG, BI score, Padua score, and whether anticoagulant therapy is administered or not. Interventions in line with relevant risk factors should be strengthened to effectively reduce the risk of stroke complicated by venous thromboembolism. -
Key words:
- Stroke /
- Venous thromboembolism /
- Risk /
- Barthel Index score /
- D-dimer
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表 1 影响脑卒中并发静脉血栓栓塞症的单因素分析
Table 1. Analysis of single factors affecting stroke complicated by venous thromboembolism
Factor A group
(n=390)B group
(n=2319)P Sex/case (%) 0.562 Male 248 (63.59) 1439 (62.05) Female 142 (36.41) 880 (37.95) Age/case (%) <0.001 ≤60 yr. 156 (40.00) 1280 (55.20) >60 yr. 234 (60.00) 1039 (44.80) Smoking/case (%) 0.150 Yes 152 (38.97) 994 (42.86) No 238 (61.03) 1325 (57.14) Drinking/case (%) 0.457 Yes 164 (42.05) 1022 (44.07) No 226 (57.95) 1297 (55.93) Hypertension/case (%) <0.001 Yes 146 (37.44) 584 (25.18) No 244 (62.56) 1735 (74.82) Diabetes/case (%) <0.001 Yes 129 (33.08) 462 (19.92) No 261 (66.92) 1857 (80.08) BMI/(kg/m2) 24.11±3.12 23.81±3.35 0.099 Bedrest time after admission/case (%) 0.000 ≥3 d 213 (54.62) 955 (41.18) <3 d 177 (45.38) 1364 (58.82) Anticoagulant therapy/case (%) 0.000 Yes 178 (45.64) 1349 (58.17) No 212 (54.36) 970 (41.83) Hcy/(μmol/L) 18.92±3.35 19.20±3.10 0.103 D-D/(mg/mL) 1.89±0.61 0.85±0.24 0.000 TG/(mmol/L) 2.35±0.42 1.95±0.57 0.000 TC/(mmol/L) 4.02±0.94 3.92±1.20 0.117 FIB/(g/L) 3.98±1.14 4.06±0.84 0.100 BI score 42.57±9.85 64.19±10.62 0.000 Padua score 6.23±1.42 4.56±1.19 0.000 BMI: body mass index; Hcy: homocysteine; D-D: D-dimer; TG: triglyceride; TC: total cholesterol; FIB: fibrinogen; BI: Barthel index. A group had venous thromboembolism; B group did not have venous thromboembolism. 
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表 2 logistic回归分析变量赋值表
Table 2. Value assignment for the variables of logistic regression analysis
Factor Assignment description Age/yr. ≤60=0, >60=1 Hypertension No=0, Yes=1 Diabetes No=0, Yes=1 Bedrest time after admission/d <3=0, ≥3=1 Anticoagulant therapy Yes=0, No=1 D-D/(mg/mL) <0.95=0, ≥0.95=1 TG/(mmol/L) <1.83=0, ≥1.83=1 BI score >9=0, ≤9=1 Padua score ≤4=0, >4=1
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表 3 影响脑卒中并发静脉血栓栓塞症的多因素分析
Table 3. Multivariate analysis of factors affecting stroke complicated by venous thromboembolism
Variable β SE Wald χ2 P OR 95% CI Age 0.794 0.267 5.989 0.014 2.212 1.311-3.733 Hypertension 0.819 0.324 8.077 0.004 2.268 1.202-4.280 Diabetes 0.836 0.337 10.070 0.002 2.307 1.192-4.466 Bedrest time after admission 0.814 0.397 6.229 0.013 2.257 1.037-4.914 Anticoagulant therapy 0.767 0.342 5.134 0.024 2.153 1.102-4.209 D-D 0.851 0.409 10.828 0.000 2.342 1.051-5.221 TG 0.687 0.218 4.977 0.026 1.988 1.297-3.047 BI score 0.708 0.315 6.500 0.011 2.030 1.095-3.764 Padua score 0.885 0.312 13.781 0.000 2.423 1.315-4.466 β: regression coefficient; SE: standard error; OR: odds ratio; CI: confidence interval.
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