MIP-1α、DFR对老年卧床静脉血栓栓塞症的预测价值

Predictive values of MIP-1α and DFR on venous thromboembolism in elderly bedridden patients

目的探讨巨噬细胞炎性蛋白因子1-α(MIP-1α)、D-二聚体/纤维蛋白原(DFR)等指标在静脉血栓栓塞症(VTE)患者中的表达及其预测价值。方法选择65周岁以上疑似VTE患者129例,根据下肢加压超声(CUS)和CT肺血管造影(CTPA)将其分为非深静脉血栓形成组(DVT组)74例、深静脉血栓形成组(DVT组)34例、肺血栓栓塞症组(PTE组)21例。在抗凝治疗前采集患者新鲜血液标本,收集血常规及凝血指标,计算中性粒细胞计数/淋巴细胞计数比值(NLR);采用免疫比浊法测定血浆D-二聚体水平,凝固法测定血浆纤维蛋白原水平,计算D-二聚体/纤维蛋白原(DFR);采用ELISA法测定血清MIP-1α的水平,实时荧光定量法检测MIP-1αmRNA的表达量。通过绘制ROC曲线分析各指标对VTE的预测价值。结果 PTE组、DVT组D-二聚体、校正后D-二聚体、DFR水平均显著高于非DVT组(P<0.05);3组纤维蛋白原差异无统计学意义。DVT组、PTE组血清MIP-1α水平高于非DVT组,PTE组低于DVT组(P<0.05)。DVT组、PTE组MIP-1αm RNA的相对表达量均高于非DVT组(P<0.05)。D-二聚体、校正后D-二聚体、DFR、MIP-1α对老年VTE均有一定诊断价值,其中校正后D-二聚体(AUC=0.864)的诊断效能最高,DFR(AUC=0.853)的诊断效能与传统D-二聚体(AUC=0.851)相当;MIP-1α(AUC=0.739)对VTE的诊断价值一般。NLR对VTE的诊断无预测价值(P>0.05)。结论校正后D-二聚体是诊断老年VTE较为理想的辅助诊断指标,DFR、MIP-1α均可作为诊断VTE的方法,MIP-1α可能是评估静脉血栓形成及不稳定脱落的新指标。

Objective To study the expression and predictive value of macrophage inflammatory protein-1α(MIP-1α)and D-dimer/fibrinogen(DFR) ratio in elderly patients with venous thromboembolism(VTE).MethodsA total of 129 suspected VTE patients over 65 years of old were enrolled in the study. According to compression ultrasonography(CUS) and CT pulmonary angiography(CTPA), patients were divided into non-DVT group(n=76), DVT group(n=34) and pulmonary thromboembolism(PTE) group(n=21). Fresh blood samples were collected from patients before the anticoagulant therapy.Data of blood routine test and clotting indicators were collected, and neutrophil count/lymphocyte count ratio(NLR) was calculated. The plasma level of D-dipolymer was measured by immunoturbidimetry. The plasma level of fibrinogen was determined by the solidification method, and DFR ratio was calculated. The expression level of MIP-1α was detected by ELISA, and the expression level of MIP-1α mRNA was detected by real-time PCR. The predicted value of some indicators for VTE was analyzed by plotting ROC curve.ResultsThe levels of D-dimer, age-adjusted D-dimer and DFR were significantly higher in PTE group and DVT group than those in non-DVT group(P<0.05). There was no significant difference in fibrinogen between the three groups. The serum levels of MIP-1α were significantly higher in DVT group and PTE group than those in non-DVT group, and compared with DVT group, the serum level of MIP-1α was lower in PTE group(P<0.05). The relative expression of MIP-1α m RNA was significantly higher in DVT group and PTE group than that in nonDVT group(P<0.05). Levels of D-dimer, age-adjusted D-dimer, DFR, MIP-1α showed certain diagnostic values for elderly VTE, and the diagnostic efficiency of age-adjusted D-dimer(AUC=0.864) was the best one. DFR(AUC=0.853) was comparable to that of the traditional D-dimer(AUC=0.851). The predictive value of MIP-1α(AUC=0.739) for VTE was a common result. NLR showed no diagnostic value for VTE(P>0.05).ConclusionThe age-adjusted D-dimer is an ideal diagnostic marker for the diagnosis of VTE in the elderly. DFR and MIP-1α can be used as a method to diagnose VTE. MIP-1α may be a new indicator for evaluating venous thrombosis and unstable shedding.