验证美国静脉论坛、国家静脉筛查计划的其他静脉严重程度评估工具与静脉临床严重程度评分（VCSS）的相关性。
Validation of Venous Clinical Severity Score (VCSS) with other venous severity assessment tools from the American Venous Forum, National Venous Screening Program.
机构信息
Section of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA.
出版信息
J Vasc Surg. 2011 Dec;54(6 Suppl):2S-9S. doi: 10.1016/j.jvs.2011.05.117. Epub 2011 Oct 1.
BACKGROUND
Several standard venous assessment tools have been used as independent determinants of venous disease severity, but correlation between these instruments as a global venous screening tool has not been tested. The scope of this study is to assess the validity of Venous Clinical Severity Scoring (VCSS) and its integration with other venous assessment tools as a global venous screening instrument.
METHODS
The American Venous Forum (AVF), National Venous Screening Program (NVSP) data registry from 2007 to 2009 was queried for participants with complete datasets, including CEAP clinical staging, VCSS, modified Chronic Venous Insufficiency Quality of Life (CIVIQ) assessment, and venous ultrasound results. Statistical correlation trends were analyzed using Spearman's rank coefficient as related to VCSS.
RESULTS
Five thousand eight hundred fourteen limbs in 2,907 participants were screened and included CEAP clinical stage C0: 26%; C1: 33%; C2: 24%; C3: 9%; C4: 7%; C5: 0.5%; C6: 0.2% (mean, 1.41 ± 1.22). VCSS mean score distribution (range, 0-3) for the entire cohort included: pain 1.01 ± 0.80, varicose veins 0.61 ± 0.84, edema 0.61 ± 0.81, pigmentation 0.15 ± 0.47, inflammation 0.07 ± 0.33, induration 0.04 ± 0.27, ulcer number 0.004 ± 0.081, ulcer size 0.007 ± 0.112, ulcer duration 0.007 ± 0.134, and compression 0.30 ± 0.81. Overall correlation between CEAP and VCSS was moderately strong (r(s) = 0.49; P < .0001), with highest correlation for attributes reflecting more advanced disease, including varicose vein (r(s) = 0.51; P < .0001), pigmentation (r(s) = 0.39; P < .0001), inflammation (r(s) = 0.28; P < .0001), induration (r(s) = 0.22; P < .0001), and edema (r(s) = 0.21; P < .0001). Based on the modified CIVIQ assessment, overall mean score for each general category included: Quality of Life (QoL)-Pain 6.04 ± 3.12 (range, 3-15), QoL-Functional 9.90 ± 5.32 (range, 5-25), and QoL-Social 5.41 ± 3.09 (range, 3-15). Overall correlation between CIVIQ and VCSS was moderately strong (r(s) = 0.43; P < .0001), with the highest correlation noted for pain (r(s) = 0.55; P < .0001) and edema (r(s) = 0.30; P < .0001). Based on screening venous ultrasound results, 38.1% of limbs had reflux and 1.5% obstruction in the femoral, saphenous, or popliteal vein segments. Correlation between overall venous ultrasound findings (reflux + obstruction) and VCSS was slightly positive (r(s) = 0.23; P < .0001) but was highest for varicose vein (r(s) = 0.32; P < .0001) and showed no correlation to swelling (r(s) = 0.06; P < .0001) and pain (r(s) = 0.003; P = .7947).
CONCLUSIONS
While there is correlation between VCSS, CEAP, modified CIVIQ, and venous ultrasound findings, subgroup analysis indicates that this correlation is driven by different components of VCSS compared with the other venous assessment tools. This observation may reflect that VCSS has more global application in determining overall severity of venous disease, while at the same time highlighting the strengths of the other venous assessment tools.
背景
有几种标准的静脉评估工具已被用作静脉疾病严重程度的独立决定因素，但这些工具之间作为整体静脉筛查工具的相关性尚未得到检验。本研究的目的是评估静脉临床严重程度评分（VCSS）及其与其他静脉评估工具相结合作为整体静脉筛查工具的有效性。
方法
从 2007 年至 2009 年，查询美国静脉论坛（AVF）、国家静脉筛查计划（NVSP）数据注册表，以获取具有完整数据集的参与者，包括 CEAP 临床分期、VCSS、改良慢性静脉功能不全生活质量（CIVIQ）评估和静脉超声结果。使用 Spearman 秩相关系数分析与 VCSS 相关的统计相关性趋势。
结果
对 2907 名参与者的 5814 条肢体进行了筛查，包括 CEAP 临床分期 C0：26%；C1：33%；C2：24%；C3：9%；C4：7%；C5：0.5%；C6：0.2%（平均值，1.41±1.22）。整个队列的 VCSS 平均评分分布（范围，0-3）包括：疼痛 1.01±0.80，静脉曲张 0.61±0.84，水肿 0.61±0.81，色素沉着 0.15±0.47，炎症 0.07±0.33，硬结 0.04±0.27，溃疡数 0.004±0.081，溃疡大小 0.007±0.112，溃疡持续时间 0.007±0.134，和压迫 0.30±0.81。CEAP 与 VCSS 之间的总体相关性为中度强（r(s)=0.49；P<0.0001），反映更严重疾病的属性相关性最高，包括静脉曲张（r(s)=0.51；P<0.0001），色素沉着（r(s)=0.39；P<0.0001），炎症（r(s)=0.28；P<0.0001），硬结（r(s)=0.22；P<0.0001），和水肿（r(s)=0.21；P<0.0001）。根据改良的 CIVIQ 评估，每个一般类别的总体平均分数包括：生活质量（QoL）-疼痛 6.04±3.12（范围，3-15），QoL-功能 9.90±5.32（范围，5-25），和 QoL-社会 5.41±3.09（范围，3-15）。CIVIQ 与 VCSS 之间的总体相关性为中度强（r(s)=0.43；P<0.0001），其中疼痛（r(s)=0.55；P<0.0001）和水肿（r(s)=0.30；P<0.0001）的相关性最高。根据静脉超声筛查结果，38.1%的肢体存在反流，在股、隐静脉或腘静脉段有 1.5%的阻塞。静脉超声总发现（反流+阻塞）与 VCSS 之间的相关性呈轻度正相关（r(s)=0.23；P<0.0001），但与静脉曲张（r(s)=0.32；P<0.0001）的相关性最高，与肿胀（r(s)=0.06；P<0.0001）和疼痛（r(s)=0.003；P=0.7947）无相关性。
结论
虽然 VCSS、CEAP、改良的 CIVIQ 和静脉超声结果之间存在相关性，但亚组分析表明，与其他静脉评估工具相比，这种相关性是由 VCSS 的不同组成部分驱动的。这一观察结果可能反映了 VCSS 在确定静脉疾病总体严重程度方面具有更广泛的应用，同时也突出了其他静脉评估工具的优势。
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