髋关节置换术后可溶性P-选择素与深静脉血栓形成相关研究

Investigation on the relationship of soluble platelet- selectin and deep vein thrombosis after hip arthroplasty

目的监测髋关节置换术后可溶性P-选择素浓度，分析其与深静脉血栓形成（DVT）的关系，探讨其对髋关节置换术后下肢DVT的诊断价值。方法选取120例行髋关节置换术的住院患者，术后根据彩色多普勒超声、临床症状及体征检查，分为DVT组和非DVT组。采集患者术前1天、术中（手术切口关闭时）、术后6h、1天、3天、7天、12天肘正中静脉血，测定可溶性P-选择素浓度、D-二聚体浓度；术前、术后3天检测凝血功能；术前和术后3、7、12天行患肢彩色多普勒超声检查；应用SPSS13．0统计学软件进行数据分析及绘制接受者操作特征曲线（ROC）。结果①可溶性P-选择素浓度在术中（手术切口关闭时）比术前有所下降，术后6h开始上升，术后1天升至相对较高浓度，术后3天降至相对较低浓度，但仍高于术前，术后7天开始逐步回升至术后12天。②DVT组与非DVT组间术前、术中可溶性P-选择素浓度比较，差异无统计学意义（P〉0．05），术后6h、1天、3天、7天、12天DVT组中可溶性P-选择素浓度明显高于非DVT组（P〈0．05）；2组的术中可溶性P-选择素与术前比较，差异无统计学意义（P〉0．05），2组术后6h、1天、3天、7天、12天可溶性P-选择素浓度与术前比较，差异均有统计学意义（P〈0．05）。③相关性分析表明：在DVT组，术后可溶性P-选择素浓度与D-二聚体浓度呈正相关（P〈0．01），术后3天可溶性P-选择素浓度与Fib呈正相关（P〈0．01）、与胛呈负相关（P〈0．01）。④ROC曲线分析：DVT组中可溶性P-选择素浓度在术后6h、1天、3天、7天、12天曲线下面积分别为0．86、0．88、0．90、0．92、0．90，诊断界点分别为38．31μg/L、43．12μg/L、36．80μg/L、38．86μg/L、39．56μg/L，灵敏度分别为84％、84％、89％、89％、89％，特异度分别为81％、88％、87％、93％、91％（P=0．00）。结论①髋关节置换术后血中可溶性P-选择素浓度升高。②可溶性P-选择素浓度与下肢DVT密切相关。③可溶性P-选择素可能是DVT早期诊断的分子标志物，对髋关节置换术后DVT的早期诊断具有重要价值。

Objective To explore the value of soluble platelet - selectin in diagnosis of deep vein thrombosis （DVT） after hip arthroplasty through monitoring soluble platelet - seleetin concentrations after operation and analyzing the correlation between soluble platelet - selectiu and DVT. Method 120 cases were selected in the study who were hospi- talized for hip arthroplasty. The subjects were divided into DVT group and non -DVT group based on postoperative color Doppler ultrasound and clinical manifestations （symptoms and signs）. Blood samples from all the subjects were collected from median cubital vein for detecting plasma concentrationss of soluble platelet - selectin （ double antibody sandwich method） and Ddimer （immuuofluorescence method） at 1 d before operation, during operation （when incision being closed） , 6 h, 1 d, 3 d, 7 d, and 12 d after operation. Clotting function （by fully automated coagulation analyzer） was detected at 3 d before and after operation. Color Doppler ultrasound for involved limb was detected at before operation and 3 d and 12 d after operation respectively. Statistical software （SPSS13.0） was used to analyze the data and to generate characteristic curve （ receiver operating characteristic curve, ROC curve）. Results ① Soluble platelet - seleetin concentrations during operation was slightly lower than that before operation. The concentrations began to rise at 6 h after operation and reached a relative high concentrations at 1 d after operation, and the concentrations decreased to a relative low- er degree at 3 d, but it was still higher than that before operation, and then it began, again, to rise gradually from 7 d to 12 d after operation. ② There were no significant difference of soluble platelet - selectin between DVT group and non -DVT group before and during operation （P 〉 0.05 ）. Soluble platelet - selectin concentrations in DVT group were signifi- cantly higher than that in non- DVT group at 6 h, 1 d, 3 d, 7 d, and 12 d after operation. There were no significant differences between soluble platelet - selectin concentrationss in the two groups before and during operation （P 〉 0.05）. There were significant differences between soluble platelet - selectin concentrations in the two groups before operation and at 6 h, 1 d, 3 d, 7 d, and 12 d after operation （P 〈0.05）. ③ Correlation analysis showed that there was significantly positive correlation between soluble platelet - selectin concentrations and D - dimer concentrations in DVT group after operation （P 〈 0.01 ）. Soluble platelet - selectin concentrations at 3 d after operation and Fib concentrations at correspond- ing time were significantly positively correlated （P 〈 0.01 ）. Soluble platelet- selectin concentrations at 3 d after operation and PT at corresponding time were significantly negatively correlated （P 〈 0.01 ）. ④ By ROC curve analysis, the ar- ea under the curve at 6 h, 1 d, 3 d, 7 d, and 12 d of soluble platelet - selectin concentrations was 0.86, 0.88, 0.90, 0.92, and 0.90 respectively. The diagnostic sector point was 38.31 μg/L, 43.12 μg/L, 36.80 μg/L, 38.86 μg/L, and 39.56 μg/L. Sensitivity was 84%, 84%, 89%, 89%, and 89%. Specificity was 81%, 88%, 87%, 93%, and 91% （P = 0.00）. Conclusions ① Soluble platelet - selectin concentrations rise after hip arthroplasty. ② Soluble platelet - selectin concentrations is closely related with DVT formation. ③ Soluble platelet - selectin may be as an early diagnostic molecular marker for DVT, and it is of great value in early diagnosis of postoperative DVT after hip arthroplasty.