北京协和医院内科老年住院患者静脉血栓栓塞症流行病学调查

Epidemiological survey of venous thromboembolism in the elderly in-patients in Internal Medicine Department of Peking Union Medical College Hospital

摘要:

目的 调查北京协和医院内科老年住院患者静脉血栓栓塞症(VTE)流行病学数据,分析老年患者VTE临床特征。方法 回顾性分析2016年5月至2016年9月北京协和医院内科住院患者3115例,根据年龄分为老年组(≥65岁,771例)和非老年组(<65岁,2344例)。收集患者基线信息、出院后随访3个月症状性VTE的发生及VTE预防情况,比较2组发生VTE的相关危险因素差异。采用SPSS 23.0软件进行统计学处理。根据数据类型,2组间比较采用t检验或χ²检验,多组间比较采用单因素方差分析。患者发生VTE的危险因素分析采用logistic回归法。结果 内科患者症状性VTE总发病率为2.50%(78/3115),老年组与非老年组患者VTE发病率分别为3.11%(24/771)和2.30%(54/2344),差异无统计学意义(P=0.249)。≥40岁的患者VTE发病率随年龄增加呈增长趋势,但各年龄段间比较差异无统计学意义。ICU老年VTE发病率最高(42.86%,3/7),且显著高于其他各科室(P＜0.05)。与非老年组比较,老年组高血压、基于Padua模型的高风险、活动性恶性肿瘤/化疗、糖尿病、冠心病、心脏和(或)呼吸衰竭、急性心肌梗死和(或)缺血性卒中比例显著增加,使用糖皮质激素治疗、炎症性肠病及血栓形成倾向比例显著降低,差异有统计学意义(P＜0.01)。多因素logistic回归分析显示,既往VTE史(OR=63.316,5%CI 19.355~207.127)及使用雌、孕激素(OR=133.278,5%CI 9.660~1838.773)是内科老年患者发生VTE的独立危险因素(P＜0.001)。有48.72%(38/78)的内科VTE患者及54.17%(13/24)的老年VTE患者在发病前未接受抗凝药物或机械预防。结论 北京协和医院内科住院患者VTE发病率随增龄呈增长趋势,应注意增加对老年患者尤其有既往VTE史和使用雌、孕激素患者的VTE事件预防。

Abstract:

Objective To explore the epidemiological and clincal features of venous thromboembolism (VTE) among the elderly in-patients in the Internal Medicine Department of Peking Union Medical College Hospital. Methods A retrospective analysis was made in 3115 hospitalized patients in the Department of Internal Medicine of Peking Union Medical College Hospital from May 2016 to September 2016. According to age, they were divided into elderly group (≥65 years old, n=771) and non-elderly group (<65 years, n=2344). Baseline information, the incidence of symptomatic VTE and VTE prophylaxis in 3 months after discharge was collected and compared, and the relative risk factors of VTE in the 2 groups were compared. SPSS statistics 23.0 was used for statistical processing. Student’s t test or Chi-square test were employed for different data types. Univariate analysis of variance was used for multigroup comparison. The risk factors of VTE were analyzed by logistic regression. Results The total morbidity rate of VTE was 2.50%(78/3115), and the incidence of VTE in the elderly and non-elderly group was 3.11%(24/771) and 2.30%(54/2344) without statistical significance (P=0.249). The incidence of VTE among the patients over 40 years old tended to increase with age, but no significant difference was observed among all age groups. The incidence of VTE in ICU was the highest (42.86%,3/7) and was significantly higher than that in other departments (P<0.05). A significant increase was seen in the elderly group against the non-elderly group in hypertension, high risk based on Padua model, active malignant tumor/chemotherapy, diabetes, coronary heart disease, heart and/or respiratory failure, acute myocardial infarction and/or ischemic stroke, while glucocorticoid treatment, inflammatory bowel disease and thrombophilic predisposition were significantly decreased (P<0.01). Multivariate logistic regression analysis showed that the history of VTE (OR=63.316,5%CI 19.355-207.127) coupled with the use of estrogen and progesterone (OR=133.278, 95%CI 9.660-1838.773) were independent risk factors for the elderly patients with VTE (P<0.001). Anticoagulant or mechanical prevention before onset was not administered in 48.72%(38/78) VTE patients and 54.17%(13/24) elderly VTE patients. Conclusion VTE incidence of in-patients in the Internal Medicine Department of Peking Union Medical College Hospital increases with age, warranting more emphasis on the prevention of VTE events in elderly patients, especially those with previous VTE history and those using estrogen and progesterone.