新型血栓标志物对骨性关节炎患者TKA术后深静脉血栓形成的诊断价值

Diagnostic value of new thrombotic marker for deep vein thrombosis after total knee arthroplasty in patients with osteoarthritis

目的研究新型血栓标志物对骨性关节炎(OA)患者全膝关节置换术(TKA)后深静脉血栓(DVT)形成的诊断价值。方法回顾性分析西安市红会医院2018年6~12月收治的79例行TKA的OA患者的临床资料,根据术后DVT是否形成分为血栓组39例和对照组40例。比较两组患者术后三天的血栓调节蛋白(TM)、凝血酶-抗凝血酶复合物(TAT)、纤溶酶-抗纤溶酶复合物(PIC)、组织型纤溶酶原激活剂-抑制物复合物(t-PAIC)和D-二聚体(D-D)的表达,受试者工作曲线(ROC)评估对DVT的诊断效能。结果血栓组与对照组的TAT[(36.99±3.25)mg/L vs(27.48±1.90)mg/L]、TM[(10.94±0.40)TU/mL vs(13.34±0.87)TU/mL]、PIC[(1.74±0.35)μg/mL vs(0.93±0.35)μg/mL]及D-D[(2.71±0.43)mg/L vs(1.63±0.28)mg/L],血栓组患者TAT、PIC和D-D明显高于对照组,TM明显低于对照组,差异均有统计学意义(P<0.05);血栓组与对照组患者tPAIC[(22.64±1.43)ng/mL vs(21.14±1.82)ng/mL]和TAT/PIC[(38.06±4.47)vs(38.03±4.84)],差异均无统计学意义(P>0.05);TAT、TM、PIC和D-D单独诊断DVT的ROC曲线下面积(AUC)分别为0.654、0.631、0.594、0.630;多指标联合诊断AUC为0.729。结论TM、TAT、PIC、D-D联合检测对OA患者TKA术后DVT的形成具有良好的诊断价值,可作为DVT的早期诊断标志物用于临床。

Objective To investigate the diagnostic value of new thrombus markers for deep vein thrombosis(DVT)in osteoarthritis(OA)patients with total knee arthroplasty(TKA).Methods This is a retrospectively analysis included a total of 79 OA patients who underwent TKA surgery in Xi'an Honghui Hospital from June 2018 to December 2018.According to the thrombus formed after surgery,the patients were divided into the DVT group(39 cases)and the control group(40 cases).The expression levels of thrombomodulin(TM),thrombin-antithrombin complex(TAT),plasmin-α-antiplasmin complex(PIC),the tissue plasminogen activator inhibitor complex(t-PAIC),and D-Dimer(D-D)in two groups were compared at three days after surgery.Receiver operating curve(ROC)was used to evaluate their diagnostic efficacy for DVT.Results The expression levels of TAT,TM,PIC,D-D in the DVT group and control group were as follow:TAT,(36.99±3.25)mg/L vs(27.48±1.90)mg/L;TM,(10.94±0.40)TU/mL vs(13.34±0.87)TU/mL;PIC,(1.74±0.35)μg/mL vs(0.93±0.35)μg/mL;D-D,(2.71±0.43)mg/L vs(1.63±0.28)mg/L;TAT,PIC,and D-D in the DVT group were significantly higher than those in the control group(P<0.05),while TM was significantly lower than that in control group(P<0.05).There was no significant difference in tPAIC and TAT/PIC between the groups(P>0.05):tPAIC(22.64±1.43)ng/m vs(21.14±1.82)ng/mL;TAT/PIC,(38.06±4.47)vs(38.03±4.84).The area under the ROC curve(AUC)of TM,TAT,PIC and D-D for the diagnosis of DVT was 0.654,0.631,0.594,and 0.630,respectively,and the AUC of combined diagnosis was 0.729.Conclusion The combined detection of TM,TAT,PIC,and D-D has much better diagnostic value for the formation of DVT in OA patients after TKA,and might be used as early diagnostic markers for DVT in the clinic.