血栓分子标志物对下肢深静脉血栓形成的诊断及抗凝疗效的评价

A evaluation of coagulation biomarkers for diagnosis and therapeutic monitoring of deep venous thrombosis of lower extremities

目的观察下肢深静脉血栓患者血栓分子标志物的变化,分析其对静脉血栓形成诊断及疗效评估的价值。方法选取2018年12月至2019年5月北京积水潭医院创伤骨科下肢骨折术后深静脉血栓形成(DVT)患者64例为DVT组,未诊断为DVT患者39例为非DVT组;同期体检健康者28例为健康人对照组。采集静脉血并检测初诊时及利伐沙班抗凝治疗1个月后血栓分子标志物,即凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2纤溶酶抑制剂复合物(PIC)、组织型纤溶酶原激活物-纤溶酶原激活物抑制剂复合物(t-PAIC)及可溶性血栓调节蛋白(sTM),并进行统计学分析。结果DVT组血浆TAT、PIC、t-PAIC、sTM水平均高于非DVT组(P均<0.05),DVT组血浆TAT、PIC、t-PAIC水平均高于健康人对照组(P均<0.05),DVT组血浆sTM水平与健康人对照组差异无统计学意义(P>0.05)。TAT、PIC、t-PAIC诊断DVT的ROC曲线下面积分别为0.997、0.980、0.758,约登指数最大时取cut-off值,cut-off值分别为2.45 ng/mL、0.715μg/mL、0.758 ng/mL;根据测定值>cut-off值为阳性,测定值<cut-off值为阴性,抗凝治疗1个月前后患者组TAT、PIC、t-PAIC水平及阳性率差异均有统计学意义(P均<0.05)。结论血栓分子标志物TAT、PIC、t-PAIC能有效发现下肢DVT,同时对评估DVT患者抗凝疗效有意义。

Objective To evaluate the changes of molecular markers of thrombosis in patients with deep venous thrombosis of lower extremities and analyze their value in the detection of venous thrombosis and evaluate the therapeutic effects.Methods In case-control study,we selected traumatic patients after surgery from Beijing Jishuitan Hospital during December 2018 to May 2019.A total of 64 patients with thrombosis were in DVT group,39 patients without thrombosis were in non-DVT group,and 28 healthy subjects in the same period were in healthy control group.Venous blood samples were taken from all these people.Coagulation parameters thrombin-antithrombin complexes(TAT),plasmin-α2-plasmin inhibitor complexes(PIC)and tissue-type plasminogen activator-inhibitor complexes(t-PAIC)were detected at first diagnosis and one month after rivaroxaban anticoagulation therapy beginning.The differences of the markers between these groups were compared.Results The coagulation markers of the patients with lower extremity deep venous thrombosis increased significantly at diagnosis.The levels of plasma TAT,PIC,t-PAIC and sTM in DVT group were significantly high-er than those in non-DVT group(P<0.05).The levels of plasma TAT,PIC and t-PAIC in DVT group were higher than those in healthy control group(P<0.05).There was no significant difference in sTM level between DVT group and healthy control group(P>0.05).The results and changes of TAT,PIC,t-PAIC in the patients before and after one month of anticoagulation therapy were statistically different(P<0.05)in comparison.Conclusion The molecular markers of thrombosis,TAT,PIC and t-PAIC,could effectively detect deep venous thrombosis of lower extremities and showed significant efficacy in evaluating the efficacy of anticoagulation therapy.