高敏C-反应蛋白、白细胞介素-6、溶血磷脂酸及D-二聚体与下肢骨折后深静脉血栓形成的相关性研究

Correlation of high-sensitivity C-reactive protein,interleukin-6,lysophosphatidic acid and D-dimer with formation of deep venous thrombosis after lower limb fracture

目的分析高敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、溶血磷脂酸(LPA)及D-二聚体(D-Dimer)与下肢骨折后深静脉血栓形成(DVT)的相关性,探讨他们在下肢骨折后DVT中的作用及机制。方法选取海南西部中心医院收治的下肢骨折患者156例,根据术后是否发生DVT将其分为2组:DVT组(n=44)和非DVT组(n=112)。监测患者术前1天、术后第1、3、5天的hs-CRP、IL-6、LPA及D-Dimer水平变化。采用SPSS 19.0统计软件进行统计学分析。应用受试者工作特征(ROC)曲线分析术后各时间点hs-CRP、IL-6、LPA及D-Dimer诊断DVT的价值。Pearson相关分析hs-CRP、IL-6、LPA及D-Dimer的相关性。结果 DVT组术后第1、3、5天的hs-CRP、IL-6、LPA及D-Dimer水平均显著高于非DVT组(P<0.05)。DVT组术后第3、5天的hs-CRP、IL-6、LPA及D-Dimer水平均显著高于第1天(P<0.05),且DVT组术后第5天的hs-CRP、IL-6、LPA及D-Dimer水平显著高于第3天(P<0.05)。非DVT组术后第5天的hs-CRP、IL-6、LPA及D-Dimer水平均显著低于第1天和第3天(P<0.05)。ROC曲线显示,术后第3天4项联合诊断DVT的AUC(95%CI)[0.961(0.896~0.994)]最高,其敏感度和特异度分别为96.8%和90.2%;在单项检测中,术后第3天D-Dimer水平诊断DVT的AUC(95%CI)[0.892(0.833~0.952)]较好,其敏感度和特异度分别为84.6%和87.3%。相关分析显示,DVT患者术后第3天hs-CRP与D-Dimer相关性最好(r=0.826,P<0.001)。结论 hs-CRP、IL-6、LPA及D-Dimer是预测DVT形成的良好指标,术后第3天4项联合诊断DVT的价值较高。

Objective To analyze the correlation of serum levels of high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),lysophosphatidic acid(LPA)and D-dimer with deep venous thrombosis(DVT)after lower limb fracture,and to explore their roles and underlying mechanism in the formation.Methods A total of 156 patients with lower limb fracture admitted in our hospital were enrolled in this study.According to whether DVT occurred after operation,they were divided into DVT group(n=44)and non-DVT group(n=112).The serum levels of hs-CRP,IL-6,LPA and D-dimer were monitored at 1 d before and in 1,3 and 5 d after operation.SPSS statistics 19.0 was used for statistical analysis.The receiver operating characteristic(ROC)curve was used to analyze the values of hs-CRP,IL-6,LPA and D-dimer in the diagnosis of DVT at various time points after operation.Pearson correlation analysis was employed to analyze the correlation among above indicators.Results The serum levels of hs-CRP,IL-6,LPA and D-dimer at 1,3 and 5 d after operation were significantly higher in the DVT group than in the non-DVT group(P<0.05).In the DVT group,the levels of these indicators were notably increased with time elapsing after operation(P<0.05).While in the non-DVT group,the levels on the 5th day were obviously lower than those on the 1st and 3rd days(P<0.05).The ROC curve analysis showed that the area under ROC curve(AUC=0.961,95%CI 0.896-0.994)for DVT diagnosis when the 4 indicators were combined together was the highest on the 3rd day after operation,with sensitivity of 96.8%and specificity of 90.2%.In the test of single indicator,the level of D-dimer on the 3rd day was best for DVT diagnosis with AUC of 0.892(95%CI 0.833-0.952),and sensitivity of 84.6%while specificity of 87.3%.Correlation analysis indicated that the hs-CRP level was well correlated with that of D-dimer on the 3rd day after operation in the DVT patients(r=0.826,P<0.001).Conclusion hs-CRP,IL-6,LPA and D-dimer are good indicators to predict the formation of DVT,and the value of combined diagnosis of DVT is quite higher on the 3rd day after operation.