凝血指标及血栓分子标志物水平对骨折患者术后深静脉血栓的预测价值

doi:10.3969/j.issn.1671-7171.2022.05.020

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摘要【目的】探讨凝血指标及血栓分子标志物水平对创伤性骨折患者术后发生深静脉血栓(DVT)的预测价值。【方法】回顾性分析2018年10月至2021年10月作者医院收治的78例创伤性骨折患者的临床资料,根据术后是否发生DVT将其分为DVT组(n=32)与非DVT组(n=46)。比较两组患者性别、年龄、合并症、骨折部位、手术时间、术中出血量、术后出血量、术后止血药物使用、术中输血、凝血指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)]、血栓分子标志物[凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2抗纤溶酶复合物(PIC)、组织型纤溶酶原激活物-纤溶酶原激活物抑制剂复合物(t-PAIC)、可溶性血栓调节蛋白(sTM)]等DVT相关因素水平,通过受试者工作特征(ROC)曲线分析FIB、D-D、TAT、PIC、t-PAIC、sTM预测患者术后发生DVT的价值,并采用多因素Logistic回归分析患者术后发生DVT的危险因素。【结果】两组患者性别、年龄、合并症、骨折部位、手术时间、术中出血量、术后出血量、APTT、PT、术后止血药物使用、术中输血,组间比较差异均无统计学意义(P>0.05)。DVT组FIB、D-D、TAT、PIC、t-PAIC、sTM显著高于非DVT组,差异有统计学意义(P<0.05);经ROC曲线分析显示,FIB=4.766 g/L、D-D=4833.945 ng/mL、TAT=6.077 ng/mL、PIC=1.089 μg/mL、t-PAIC=7.754 ng/mL、sTM=8.552 TU/mL是预测骨折患者术后发生DVT的最佳截断值;Logistic回归分析显示,FIB≥4.766 g/L、D-D≥4833.945 ng/mL、TAT≥6.077 ng/mL、PIC≥1.089 μg/mL、t-PAIC≥7.754 ng/mL、sTM≥8.552 TU/mL是骨折患者术后发生DVT的危险因素(P<0.05)。【结论】创伤性骨折患者术后DVT风险与FIB、D-D、TAT、PIC、t-PAIC、sTM水平有关,应对其凝血指标及血栓分子标志物水平密切监测,以防术后DVT的发生。

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	王勇
	鱼红进

关键词 ：创伤和损伤, 骨折/外科学, 静脉血栓形成, 血液凝固

Abstract：【Objective】 To investigate the value of coagulation indexes and thrombus molecular markers in predicting postoperative deep venous thrombosis (DVT) in patients with traumatic fracture. 【Methods】 The clinical data of 78 patients with traumatic fracture treated in the author's Hospital from October 2018 to October 2021 were analyzed retrospectively. According to whether DVT occurred after operation, they were divided into DVT group (n=32) and non DVT group (n=46). The gender, age, complications, fracture site, operation time, intraoperative bleeding, postoperative bleeding, use of postoperative hemostatic drugs, intraoperative blood transfusion, coagulation indexes [prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-Dimer (D-D)], thrombin antithrombin complex (TAT), plasmin were compared between the two groups ; the levels of DVT related factors such as anti plasmin complex (PIC)-α2, tissue plasminogen activator plasminogen activator inhibitor complex (t-PAIC), soluble thrombomodulin (sTM) were analyzed. The value of FIB, D-D, TAT, PIC, t-PAIC and sTM was predicted by ROC, and the risk factors of postoperative DVT were determined by multivariate logistic regression analysis. 【Results】 There was no significant difference in gender, age, complications, fracture site, operation time, intraoperative bleeding, postoperative bleeding, APTT, PT, use of postoperative hemostatic drugs and intraoperative blood transfusion between the two groups (P>0.05). FIB, D-D, TAT, PIC, t-PAIC and sTM in the DVT group were significantly higher than those in the non DVT group (P<0.05); By ROC analysis, FIB=4.766 g/L, D-D=4833.945 ng/mL, TAT=6.077 ng/mL, PIC=1.089 μ G/mL, t-PAIC=7.754 ng/mL and sTM=8.552 TU/mL were the best cutoff values for predicting postoperative DVT in patients with fracture; Logistic regression analysis showed that FIB≥4.766 g/L, D-D≥4833.945 ng/mL, TAT≥6.077 ng/mL and PIC≥1.089 μ G/mL, t-PAIC≥7.754 ng/mL and sTM≥8.552 TU/mL were the risk factors of postoperative DVT in patients with fracture (P<0.05). 【Conclusion】 The risk of postoperative DVT in patients with traumatic fracture is related to the levels of FIB, D-D, TAT, PIC, t-PAIC and sTM. The levels of coagulation indexes and thrombus molecular markers should be closely monitored to prevent the occurrence of postoperative DVT.

Key words： Wounds and Injuries Fractures, Bone/SU Venous Thrombosis Blood Coagulation

收稿日期: 2022-03-28

中图分类号:

R683

通讯作者: *E-mail:1244540498@qq.com

引用本文:

王勇, 鱼红进. 凝血指标及血栓分子标志物水平对骨折患者术后深静脉血栓的预测价值[J]. 医学临床研究, 2022, 39(5): 713-716.
WANG Yong, YU Hong-jing. Value of Coagulation Indexes and Thrombus Molecular Markers in Predicting Postoperative Deep Venous Thrombosis in Patients with Fracture. JOURNAL OF CLINICAL RESEARCH, 2022, 39(5): 713-716.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2022.05.020 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2022/V39/I5/713

[1] JIN Z,LV H,LI M, et al. Epidemiological investigation of hospitalized patients with traumatic fractures: a cross-sectional study[J].J Int Med Res,2021, 49(1):305-309.
[2] MINEKAWA T,LIMA M,MORAES A, et al. Typical acute traumatic fracture healing in an 83-year-old man undergoing 223Ra treatment for prostatic cancer bone metastases[J].Clin Nucl Med,2020, 45(9):683-686.
[3] TAYLOR A,MARTINEZ-QUINONES P,HUANG E, et al. Effective use of weight-based enoxaparin for deep vein thrombosis chemoprophylaxis in patients with traumatic brain injury[J].Am J Surg,2022,223(1):146-150.
[4] 中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南(第三版)[J].中华普通外科杂志,2017,32(9):807-812.
[5] WHITE C,NOBLE S,SWAN F, et al. Hospice inpatient deep vein thrombosis detection (HIDDen) in advanced non-malignant diseases : A longitudinal pilot study[J].BMJ Support Palliat Care,2019,13(5):31-35.
[6] CHARISIS N,HARB H,HARB M, et al. A systematic review on long-term clinical impact in patients with iliofemoral deep vein thrombosis[J].Phlebology,2021,36(9):710-718.
[7] PAGLIARI M T,BOSCARINO M, CAIRO A, et al. ADAMTS13 activity, high VWF and FVⅢ levels in the pathogenesis of deep vein thrombosis[J].Thromb Res,2021, 197:132-137.
[8] 钞润锁, 王子平. 创伤性四肢骨折患者血液流变学及凝血指标的改变及临床意义[J].血栓与止血学, 2021, 27(3):469-470.
[9] WENGER N,SEBASTIAN T,ENGELBERGER R P,et al.Pulmonary embolism and deep vein thrombosis: Similar but different[J].Thromb Res,2021,206:88-98.
[10] 王彩云, 高山, 陈文恒. 老年车祸所致骨折患者创伤性应激障碍的发生情况及影响因素[J].国际精神病学杂志, 2021, 48(2):330-332.
[11] 蔡金玉, 钟海燕, 杨璐丹,等. 不同部位创伤骨折病人D-二聚体,纤维蛋白原水平的临床意义分析[J].蚌埠医学院学报, 2020, 45(1):57-60.
[12] STAWIARSKI K,LOUTOO A,VELARDI L, et al. D-dimer driven deep vein thrombosis prophylaxis strategy for hospitalized patients with COVID-19[J].Thromb Res,2021, 201:151-153.
[13] 高慧, 何婷婷, 高玲. 凝血功能指标与创伤性骨折患者术后深静脉血栓形成的关系[J].血栓与止血学, 2021, 27(1):112-113.
[14] 祁亚宁, 王利新, 刘辉,等. 血清TM、P-selectin、HDL-C以及凝血功能指标与创伤性骨折患者术后深静脉血栓形成的关系研究[J].现代生物医学进展, 2021, 21(16):3131-3135.
[15] 王枫, 冯宝华, 雷博艺. 低相对分子质量肝素钙预防老年下肢创伤骨折患者术后深静脉血栓形成的疗效[J].血栓与止血学, 2020, 26(4):669-670.
[16] 胡艳晶, 张益明, 宋景春,等. 凝血酶-抗凝血酶复合物联合纤溶酶-α2抗纤溶酶复合物诊断创伤性弥散性血管内凝血的临床价值[J].医学研究生学报, 2020,33(12):1283-1287.
[17] 王振群, 章文洁, 吴俊. 血栓分子标志物联合Caprini评分预测创伤性下肢骨折后深静脉血栓形成风险[J].中华检验医学杂志, 2021, 44(12):1170-1175.
[18] 谢祖全, 陈建卓. 老年下肢骨折患者凝血功能及纤溶活性指标与深静脉血栓形成的相关性[J].血栓与止血学, 2021, 27(2):289-290.