术前血清瘦素水平对骨关节炎患者全膝关节置换术后继发深静脉血栓的预测价值

Predictive value of preoperative serum leptin level on secondary deep vein thrombosis after total knee arthroplasty in patients with osteoarthritis

目的:分析原发性膝骨关节炎(OA)患者术前血清瘦素水平与全膝关节置换术(TKA)后深静脉血栓(DVT)风险之间的关系,为DVT早期筛查工作提供新的生物学标志物。方法:收集2017年3月至2020年3月我院收治的280例因严重原发性膝OA而接受TKA治疗的患者的血清样本,根据术后5 d行双下肢深静脉彩色多普勒超声检查结果将患者分为DVT组和非DVT组。比较两组患者术前血清瘦素水平。采用单因素和多因素Logistic模型分析血清瘦素水平与骨关节炎(OA)患者TKA后继发DVT的关系。采用ROC曲线分析血清瘦素水平对OA患者TKA后继发DVT的预测价值。采用Pearson法分析DVT组患者血清瘦素水平与其他生化指标的关系。结果:DVT组患者术前血清瘦素水平42.54(27.25,62.02)ng·ml^(-1),高于非DVT组的19.82(12.86,29.22)ng·ml^(-1)(P<0.05)。经单因素和多因素Logistic回归分析,血清瘦素水平≥20.85 ng·ml^(-1)是OA患者TKA后继发DVT的独立危险因素(P<0.05)。血清瘦素水平对OA患者TKA后继发DVT的ROC曲线下面积为0.847(95%CI:0.790~0.904),对应截断值为25.325 ng·ml^(-1),特异度为72.6%,敏感度为83.6%。血清瘦素水平与HDL-C(r=-0.344,P<0.001)、CRP(r=0.231,P=0.001)、TNF-α(r=0.381,P<0.001)有一定的相关性。结论:术前血清瘦素高表达水平是TKA继发DVT的独立危险因素,可作为有效的预测OA患者TKA后继发DVT风险的生物标志物。

Objective:To analyze the relationship between preoperative serum leptin level and the risk of deep vein thrombosis(DVT)after total knee arthroplasty(TKA)in patients with primary knee osteoarthritis(OA),and to provide a new biomarker for the early screening of DVT.Methods:Serum samples were collected from 280 patients admitted to our hospital from March 2017 to March 2020 who received TKA treatment for severe primary knee OA and divided into DVT group and non-DVT group according to color doppler ultrasound examination of deep veins of both lower limbs 5 days after operation.The serum leptin level before operation was compared between the two groups.Univariate and multivariate Logistic models were used to analyze the relationship between serum leptin level and secondary DVT in OA patients after TKA.ROC curve was used to analyze the predictive value of serum leptin level on secondary DVT in OA patients after TKA.The relationship between serum leptin level and other biochemical indexes in DVT group was analyzed by Pearson method.Results:The preoperative serum leptin level of DVT group[42.54(27.25,62.02)ng·ml^(-1)]was higher than that of non-DVT group[19.82(12.86,29.22)ng·ml^(-1)],P<0.05.Univariate and multivariate Logistic regression analysis showed that serum leptin level≥20.85 ng·ml^(-1) was an independent risk factor for secondary DVT in OA patients after TKA(P<0.05).The area under the ROC curve of serum leptin level in OA patients with secondary DVT after TKA was 0.847(95%CI:0.790-0.904),the corresponding cutoff value was 25.325 ng·ml^(-1),the specificity and sensitivity were 72.6%and 83.6%,respectively.The serum leptin level had a certain correlation with HDL-C(r=-0.344,P<0.001),CRP(r=0.231,P=0.001),and TNF-α(r=0.381,P<0.001).Conclusion:High preoperative serum leptin expression level is an independent risk factor for secondary DVT after TKA,which can be used as an effective biomarker to predict the risk of secondary DVT in OA patients after TKA.