使用皇家妇产科医师学院（RCOG）风险评估模型和生物标志物评估产后静脉血栓栓塞的风险。
Use of the RCOG risk assessment model and biomarkers to evaluate the risk of postpartum venous thromboembolism.
作者信息
Li Hua, Wan Sheng, Pei Jindan, Zhang Lu, Peng Jing, Che Ronghua
机构信息
Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
出版信息
Thromb J. 2023 Jun 12;21(1):66. doi: 10.1186/s12959-023-00510-6.
BACKGROUND
Venous thromboembolism (VTE) is a leading cause of morbidity and mortality during pregnancy and the puerperium. The vast majority of VTE occurs after childbirth. China has not yet established standard risk assessment model for postpartum venous thromboembolism (VTE), the Royal College of Obstetricians and Gynecologists (RCOG) risk assessment model (RAM) is commonly used in clinic at present. Herein, we aimed to evaluate the validity of the RCOG RAM in the Chinese population and try to formulate a local risk assessment model by combining with other biomarkers for VTE prophylaxis.
METHODS
The retrospective study was conducted from January 2019 to December 2021at Shanghai First Maternity and Infant Hospital which has approximately 30,000 births annually, and the incidence of VTE, differences between RCOG-recommended risk factors, and other biological indicators from medical records were evaluated.
RESULTS
The study included VTE (n = 146) and non-VTE(n = 413) women who examined by imaging for suspicion of postpartum VTE. There was no statistical difference in the incidence rate of postpartum VTE between the low-score group (23.8%) and the high-score group (28%) after stratification by RCOG RAM. However, we found that cesarean section (in the low-score group), white blood cell (WBC) ≥ 8.64*10^9/L (in the high-score group), low-density lipoprotein(LDL) ≥ 2.70 mmol/L, and D-dimer ≥ 3.04 mg/L (in both groups) were highly associated with postpartum VTE. Subsequently, the validity of the RCOG RAM combined with biomarkers as a model for the risk assessment of VTE was estimated and the results showed that this model has good accuracy, sensitivity, and specificity.
CONCLUSIONS
Our study indicated that the RCOG RAM was not the best strategy for predicting postpartum VTE. Combined with some biomarkers (including the value of LDL and D-Dimer, and WBC count), the RCOG RAM is more efficient when identifying high-risk groups of postpartum VTE in the Chinese population.
TRIAL REGISTRATION
This purely observational study does not require registration based on ICMJE guidelines.
背景
静脉血栓栓塞症（VTE）是妊娠和产褥期发病和死亡的主要原因。绝大多数VTE发生在产后。中国尚未建立产后静脉血栓栓塞症（VTE）的标准风险评估模型，目前临床上常用英国皇家妇产科医师学院（RCOG）风险评估模型（RAM）。在此，我们旨在评估RCOG RAM在中国人群中的有效性，并尝试通过结合其他生物标志物制定本地风险评估模型以预防VTE。
方法
本回顾性研究于2019年1月至2021年12月在上海第一妇婴保健院进行，该院每年约有30000例分娩，评估了VTE的发生率、RCOG推荐的风险因素之间的差异以及病历中的其他生物学指标。
结果
该研究纳入了因怀疑产后VTE而接受影像学检查的VTE患者（n = 146）和非VTE患者（n = 413）。根据RCOG RAM分层后，低分组（23.8%）和高分组（28%）的产后VTE发生率无统计学差异。然而，我们发现剖宫产（低分组）、白细胞（WBC）≥8.64×10^9/L（高分组）、低密度脂蛋白（LDL）≥2.70 mmol/L以及D-二聚体≥3.04 mg/L（两组均是）与产后VTE高度相关。随后，评估了RCOG RAM联合生物标志物作为VTE风险评估模型的有效性，结果表明该模型具有良好的准确性、敏感性和特异性。
结论
我们的研究表明，RCOG RAM并非预测产后VTE的最佳策略。结合一些生物标志物（包括LDL和D-二聚体的值以及WBC计数），RCOG RAM在识别中国人群中产后VTE高危组时更有效。
试验注册
根据国际医学杂志编辑委员会（ICMJE）指南，这项纯观察性研究无需注册。
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