可溶性细胞表面分化抗原40配体在下肢深静脉血栓形成患者外周血中的表达

Expression of souluble CD40L in peripheral blood of patients with different stages of lower-extremity deep venous thrombosis

目的分析下肢深静脉血栓形成(DVT)的诱发因素及其临床特点,并探讨可溶性细胞表面分化抗原40配体(sCD40L)用于早期诊断DVT的临床价值。方法回顾性收集2012年1月至2017年1月期间入住南充市中心医院血管外科尚未接受抗凝、溶栓治疗的下肢DVT患者,根据DVT的临床病程分为急性早期、急性中期、急性后期及亚急性期,检测DVT患者外周血中sCD40L表达水平。结果本研究共收集符合纳入标准的DVT患者100例,其中急性早期31例,急性中期26例,急性后期21例,亚急性期22例;中央型28例,周围型66例,混合型6例。(1) DVT发病诱因从高到低分别是骨折(27.0%)、恶性肿瘤(21.0%)、胸腹部术后(20.0%)、关节置换术后(18.0%)及剖宫产(6.0%)。(2)急性早期DVT者较多见于骨折后(54.8%),急性中、后期多见于关节置换术后(分别为26.9%、38.1%),而亚急性期多以恶性肿瘤为主(50.0%)。(3)与对照组(同期20名体检健康人群)比较,不同临床病程DVT患者外周血中sCD40L表达均显著升高(P<0.05);处于不同病程的DVT患者sCD40L表达水平比较差异有统计学意义(F=26.57,P=0.02),在急性早期中sCD40L表达即达最高,随后逐渐下降(P<0.05)。(4)周围型、中央型及混合型患者外周血中sCD40L表达水平三者间总体比较差异有统计学意义(F=12.51,P=0.02),进一步两两分析结果显示,其在中央型和混合型中均明显高于周围型(P<0.05),但在中央型与混合型间比较差异无统计学意义(P>0.05)。结论 sCD40L可能在早期诊断DVT及判断血栓范围即严重程度方面有潜在的临床应用价值。

Objective To analyze inducing factors and clinical characteristics of deep venous thrombosis (DVT) and to explore clinical value of soluble cell surface differentiation antigen 40 ligand (sCD40L)in early diagnosis of DVT. Methods The patients with the DVT of lower extremity who had not received the anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2017 were collected,these patients were divided into an early-acute stage,mid-acute stage,late-acute stage,and subacute stage according to the clinical course of DVT.The sCD40L expression in the peripheral blood of DVT patients were detected by the enzyme linked immunosorbent assay. Results There were 100 patients with the DVT were included,including 31 cases of early-acute stage,26 cases of midacute stage,21 cases of late-acute stage,and 22 cases of subacute stage;66 patients with the peripheral type,28 patients with the central type,and 6 patients with the mixed type.①The fracture,malignant tumor,long time in the bed following the thoracic or abdominal operation,joint replacement,and caesarean section were the successively main risk factors of the DVT.②The early-acute stage of DVT was more common in the fracture patients,the mid-and late-acute stage of DVT often occurred in the joint replacement sufferer,and the subacute stage of DVT was usually found in the malignant tumor patients.③The sCD40L expression in the patients with the different stage DVT was signifiantly higher than that in the control group (20 healthy people in the physical examination,P<0.05).Furthermore,there was a significant difference in the different stage DVT patients (F=26.57,P=0.02),that is,the expression of sCD40L was the highest in the early-acute stage of DVT,and then gradually reduced (P<0.05).④The sCD40L expression had a significant difference among the central type DVT,mixed type DVT,and peripheral type DVT (F=12.51,P=0.02),which in the peripheral type DVT was significantly higher than that of the central type DVT (P<0.05)and mixed type DVT (P<0.05),but had no difference between the central type DVT and the mixed type DVT (P>0.05).Conclusion sCD40L might act as a blood index of early diagnosis and)udgement of extent of DVT, especially be helpful in early-acute stage of DVT.