血栓调节蛋白对肺癌患者静脉血栓栓塞的预测价值

The predictive value of thrombomodulin for venous thromboembolism in patients with lung cancer

目的探讨血栓调节蛋白(TM)对肺癌患者静脉血栓栓塞(VTE)的预测价值。方法回顾性分析2020年3月至2021年3月洪湖市人民医院356例肺癌患者的临床资料。其中,发生VTE 71例(VTE组),未发生VTE 285例(非VTE组)。两组患者均检测D-二聚体(DD)、纤维蛋白原降解产物(FDP)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)和TM。采用多因素Logistic回归分析影响肺癌患者发生VTE的独立危险因素,受试者工作特征(ROC)曲线分析TM对肺癌患者发生VTE的预测价值。结果两组FDP、PT、APTT、TT比较差异无统计学意义(P>0.05);VTE组TM和DD明显高于非VTE组[(11.61±3.22)U/L比(7.70±2.59)U/L和(5.42±2.15)mg/L比(2.57±0.96)mg/L],差异有统计学意义(P<0.01)。多因素Logistic回归分析结果显示,TM和DD是影响肺癌患者发生VTE的独立危险因素(OR=0.27和0.66,95%CI 0.19~0.39和0.56~0.78,P<0.01)。ROC曲线分析结果显示,TM和DD预测肺癌患者发生VTE的曲线下面积为0.830和0.892(95%CI 0.772~0.889和0.842~0.941),两者比较差异无统计学意义(Z=1.617,P>0.05);TM和DD最佳截断值为9.39 U/L和3.83 mg/L,灵敏度为77.46%和76.06%,特异度为73.33%和91.58%。结论TM可作为肺癌患者发生VTE的预测指标。

Objective To explore the predictive value of thrombomodulin(TM)for venous thromboembolism(VTE)in patients with lung cancer.Methods The clinical data of 356 patients with lung cancer from March 2020 to March 2021 in Honghu People′s Hospital were retrospectively analyzed.Among them,71 cases were diagnosed as VTE(VTE group)and 285 cases without VTE(non-VTE group).The D-Dimer(DD),fibrinogen degradation product(FDP),prothrombin time(PT),activated partial prothrombin time(APTT),thrombin time(TT)and TM were detected.Multivariate Logistic regression analysis was used to analyze the independent risk factors of VTE in patients with lung cancer,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of TM for VTE in patients with lung cancer.Results There were no statistical differences in FDP,PT,APTT and TT between 2 groups(P>0.05);the TM and DD in VTE group were significantly higher than those in non-VTE group:(11.61±3.22)U/L vs.(7.70±2.59)U/L and(5.42±2.15)mg/L vs.(2.57±0.96)mg/L,and there were statistical differences(P<0.01).Multivariate Logistic regression analysis results showed that TM and DD were independent risk factors for VTE in patients with lung cancer(OR=0.27 and 0.66,95%CI 0.19 to 0.39 and 0.56 to 0.78,P<0.01).ROC curve analysis result showed that the areas under curve of TM and DD for prediction VTE in patients with lung cancer were 0.830 and 0.892(95%CI 0.772 to 0.889 and 0.842 to 0.941),and there was no statistical difference(Z=1.617,P>0.05);the optimum cut off values of TM and DD were 9.39 U/L and 3.83 mg/L,the sensitivity was 77.46%and 76.06%,and the specificity was 73.33%and 91.58%.Conclusions The TM can be used as prediction index for VTE in patients with lung cancer.