血栓分子标志物预警全膝关节置换后并发静脉血栓栓塞的作用

Early warning efficacy of thrombus molecular markers after total knee arthroplasty in patients complicated with venous thromboembolism

背景:全膝关节置换后存在感染、心律失常、肺栓塞、心力衰竭、深静脉血栓形成等并发症,而静脉血栓栓塞症是引起手术失败的重要危险因素,因此有效的术后血栓监测尤为重要。目的:探讨血栓分子标志物在全膝关节置换患者术后并发静脉血栓栓赛的预警价值。方法:回顾性分析2021年4-7月在河北省中西医结合医院行全膝关节置换患者的病历资料,共纳入80例患者,以术后3 d血栓是否形成分为血栓组(n=39)与无栓组(n=41),选择同期健康体检者40名作为对照组。3组均检测血清血栓分子标志物水平(凝血酶-抗凝血酶复合物、纤溶酶-α2纤溶酶抑制物复合物、血栓调节蛋白、组织型纤溶酶原激活剂-纤溶酶原激活剂抑制剂1复合物),全膝关节置换患者于术前当天与术后8 h检测,对照组检测1次。结果与结论:①术前当天:无栓组患者的凝血酶-抗凝血酶复合物、纤溶酶-α2纤溶酶抑制物复合物水平均高于对照组(P<0.05),血栓组患者的凝血酶-抗凝血酶复合物和血栓调节蛋白水平均高于无栓组(P<0.05),血栓组患者4种血栓分子标志物水平均高于对照组(P<0.05);②术后8 h:血栓组患者的血栓分子标志物水平均高于无栓组(P<0.05);③Logistics回归分析显示,术前单指标血栓调节蛋白的预测效能最好(ACU=0.814,灵敏度76.70%,特异度83.80%,P=0.000),凝血酶-抗凝血酶复合物和血栓调节蛋白联合检测提高了预测效能(ACU=0.822,灵敏度83.30%,特异度76.80%,P=0.000);术后单指标凝血酶-抗凝血酶复合物的预测效能最好(ACU=0.898,灵敏度83.30%,特异度84.80%,P=0.000),凝血酶-抗凝血酶复合物和纤溶酶-α2纤溶酶抑制物复合物联合检测提高了预测效能(ACU=0.897,敏感度88.30%,P=0.000);④Spearman直线相关分析显示,术后组织型纤溶酶原激活剂-纤溶酶原激活剂抑制剂-1复合物与纤溶酶-α2纤溶酶抑制物复合物呈现出良好的正相关(r2=0.209,P<0.05);⑤血栓调节蛋白可作为全膝关节置换术前的早期预警指标,凝血酶-抗凝血酶复合物作为临近静脉血栓栓塞发生的特异指标,4种指标联合检测能提升深静脉血栓栓塞的预警效能。

BACKGROUND:Complications such as infection,arrhythmia,pulmonary embolism,heart failure,and deep vein thrombosis exist after total knee arthroplasty,and venous thromboembolism is an important risk factor for surgical failure.Therefore,effective postoperative thrombosis monitoring is particularly important.OBJECTIVE:To discuss the early warning value of thrombus molecular markers in the patients after total knee arthroplasty complicated with venous thromboembolism.METHODS:A retrospective analysis of the data of 80 patients,who received total knee arthroplasty in Hebei Hospital of Integrated Traditional Chinese and Western Medicine between April and July 2021,was performed.The patients were divided into thrombus group(n=39)and non-thrombus group(n=41)based on thrombus formation 3 days after operation.Totally 40 people who had a health checkup during the same period were chosen as the control group.Thrombus molecular markers were tested in each group:thrombin-antithrombin complex,plasmin-antiplasmin complex,thrombomodulin,and tissue plasminogen activator inhibitory complex.The markers were examined in total knee arthroplasty patients on the day before surgery and 8 hours after surgery.The markers were tested once in the control group.RESULTS AND CONCLUSION:(1)One day before surgery:thrombin-antithrombin complex and plasmin-antiplasmin complex levels in the non-thrombus group were higher than those in the control group(P<0.05).Thrombin-antithrombin complex and thrombomodulin levels in the thrombus group were higher than those in the non-thrombus group(P<0.05).The thrombus molecular marker levels of the thrombus group were higher than those in the control group(P<0.05).(2)At 8 hours postoperatively,the thrombus molecular marker levels of the thrombus group were higher than those in the non-thrombus group(P<0.05).(3)Logistics regression analysis showed that the single index thrombomodulin had the best prediction efficiency(ACU=0.814,sensitivity 76.70%,specificity 83.80%,P=0.000).Combined detection of thrombin-antithrombin complex and thrombomodulin could improve prediction efficiency(ACU=0.822,sensitivity 83.30%,specificity 76.80%,P=0.000).The single index thrombin-antithrombin complex had the best prediction efficiency(ACU=0.898,sensitivity 83.30%,specificity 84.80%,P=0.000).Combined detection of thrombin-antithrombin complex and plasmin-antiplasmin complex could improve prediction efficiency(ACU=0.897,sensitivity 88.30%,P=0.000).(4)Spearman’s linear correlation analysis showed that tissue plasminogen activator inhibitory complex and plasminantiplasmin complex had a good positive correlation(r2=0.209,P<0.05).(5)It is concluded that thrombomodulin can be used as an early warning indicator before total knee arthroplasty.Thrombin-antithrombin complex is a specific indicator of venous thromboembolism occurrence.Combined detection of thrombin-antithrombin complex,plasmin-antiplasmin complex,thrombomodulin,and tissue plasminogen activator inhibitory complex can improve prediction efficiency for venous thromboembolism.