Venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case-control analysis
Venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case-control analysis
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DOI：
10.1136/bmjopen-2016-012665
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发表时间：
2017-03-01
期刊：
影响因子：
2.9
通讯作者：
Qureshi, Nadeem
中科院分区：
文献类型：
--
作者：
Little, Iain;Vinogradova, Yana;Qureshi, Nadeem
目的：为了确定镰状细胞携带者（“镰状细胞特征”）有增加的静脉血栓栓塞（VTE）的风险。设计：嵌套病例对照分析的队列研究。设置：一般人群，数据来自临床实践研究数据链（CPRD）中的609个英国一般实践。参与者：所有在1998年至2013年期间注册CPRD全科诊所的患者，其医疗记录为18至75岁之间的镰状细胞筛查。主要结果指标：镰状细胞携带者和非携带者之间每10000人年（PY）的VTE发病率;以及镰状细胞携带者与非携带者之间VTE的校正OR。我们纳入了30424例接受镰状细胞筛查的患者，随访时间为179503 PY，在6758名镰状细胞携带者中鉴定出55例VTE，在23666名非携带者中鉴定出125例VTE。镰状细胞携带者的VTE发生率（14.9/10 000 PY; 95% CI 11.4 - 19.4）显著高于非携带者（8.8/10 000 PY; 95% CI 7.4 - 10.4）。将分析限制于确认的非携带者是不显著的，但在小样本上进行。在病例对照分析中（180例病例与1775例对照组按年龄和性别匹配），在调整体重指数、怀孕、吸烟状况和种族后，镰状细胞携带者的VTE风险仍然增加（OR 1.78，95% CI 1.18 - 2.69，p=0.006），肺栓塞（PE）风险最高结论：虽然绝对数量很小，但在一般人群中筛查镰状细胞，携带者比非携带者有更高的VTE，特别是PE的发病率和风险。临床医生在镰状细胞携带者的临床护理中或在讨论携带者筛查时应意识到这种风险升高，并明确注意这些个体中VTE的可改变风险因素。对携带者状态进行更完整的初级保健编码可以改善分析。
Objective: To determine whether sickle cell carriers ('sickle cell trait') have an increased risk of venous thromboembolism (VTE).Design: Cohort study with nested case-control analysis.Setting: General population with data from 609 UK general practices in the Clinical Practice Research Datalink (CPRD).Participants: All individuals registered with a CPRD general practice between 1998 and 2013, with a medical record of screening for sickle cell between 18 and 75 years of age.Main outcomes measures: Incidence of VTE per 10 000 person-years (PY) among sickle cell carriers and non-carriers; and adjusted OR for VTE among sickle cell carriers compared with non-carriers.Results: We included 30 424 individuals screened for sickle cell, with a follow-up time of 179 503 PY, identifying 55 VTEs in 6758 sickle cell carriers and 125 VTEs in 23 666 non-carriers. VTE incidence among sickle cell carriers (14.9/10 000 PY; 95% CI 11.4 to 19.4) was significantly higher than non-carriers (8.8/10 000 PY; 95% CI 7.4 to 10.4). Restricting analysis to confirmed non-carriers was non-significant, but performed on a small sample. In the case-control analysis (180 cases matched to 1775 controls by age and gender), sickle cell carriers remained at increased risk of VTE after adjusting for body mass index, pregnancy, smoking status and ethnicity (OR 1.78, 95% CI 1.18 to 2.69, p=0.006), with the greatest risk for pulmonary embolism (PE) (OR 2.27, 95% CI 1.17 to 4.39, p=0.011).Conclusions: Although absolute numbers are small, in a general population screened for sickle cell, carriers have a higher incidence and risk of VTE, particularly PE, than non-carriers. Clinicians should be aware of this elevated risk in the clinical care of sickle cell carriers, or when discussing carrier screening, and explicitly attend to modifiable risk factors for VTE in these individuals. More complete primary care coding of carrier status could improve analysis.