出凝血分子标志物在骨科术后下肢深静脉血栓形成的诊断价值

The Value of Coagulation Molecular Markers in the Diagnosis of Lower Extremity Deep Vein Thrombosis after Orthopedic Surgery

目的探讨出凝血分子标志物对骨科患者术后下肢深静脉血栓形成(deep venous thrombosis,DVT)诊断中的应用价值。方法收集2020年10月至2021年7月于宁夏回族自治区人民医院创伤骨科行下肢骨折手术患者142例,分为DVT组(68例),非DVT组(74例),选取同期健康体检者(40例)为健康对照组。比较三组入选者血浆TAT、TM、PIC、t-PAIC、FDP和DD水平差异;ROC曲线分析各项指标对诊断DVT的敏感性、特异性及最佳截断值。结果血浆各分子标记物水平DVT组均高于非DVT组和健康对照组(P均<0.05),非DVT组均高于健康对照组(P均<0.05)。ROC曲线显示,TAT、PIC、TM、t-PAIC、DD、FDP的曲线下面积(AUC)分别为0.849、0.842、0.675、0.702、0.811和0.796,TAT+PIC、TAT+PIC+TM+t-PAIC、DD+FDP+PIC+TAT、TAT+PIC+TM+t-PAIC+DD+FDP诊断骨科术后患者下肢深静脉血栓形成的AUC高于DD+FDP(0.922、0.927、0.963和0.966 vs.0.872)。结论TAT、PIC的敏感度和特异性均比较高,可作为DVT诊断的良好指标,当联合其他出凝血分子标记物DD、FDP、TM、t-PAIC检测时,可提高骨科患者术后DVT形成早期诊断率,为临床早期干预和治疗提供最佳时机。

Objective To observe the changes of different coagulation biomarkers in patients with deep venous thrombosis(DVT)of lower extremities and to explore its diagnostic value for venous thrombosis after orthopedic surgery.Methods One hundred and forty-two patients with lower extremity fractures who were hospitalized at Ningxia People’s Hospital from October 2020 to July 2021 were enrolled in this study.Totally 68 patients with thrombosis were defined as DVT group and 74 patients without thrombosis defined as non-DVT group,and 40 healthy examinees were selected as healthy control group.Levels of TAT,TM,PIC,t-PAIC,FDP and DD in plasma were compared among the three groups.Receiver operating characteristic(ROC)curve was used to determine the values of TAT,TM,PIC t-PAIC,FDP and DD in diagnosing DVT in patients with lower extremities.Results The levels of plasma TAT,PIC,TM,t-PAIC,DD and FDP in DVT group were higher than those in non-DVT group and healthy control group(P all<0.05),and the non-DVT group was higher than the healthy control group.The area under ROC curve(AUC)values of TAT,PIC,TM,t-PAIC,DD and FDP were 0.849,0.842,0.675,0.702,0.811 and 0.796,respectively.The analysis of ROC curve for combined biomarkers showed that the AUC values of TAT+PIC,TAT+PIC+TM+t-PAIC,DD+FDP+PIC+TAT,TAT+PIC+TM+t-PAIC+DD+FDP were higher than that of DD+FDP(0.922,0.927,0.963 and 0.966 vs.0.872).Conclusion The sensitivity and specificity of TAT and PIC are relatively high,which can be used as good indicators for the diagnosis of DVT.When combined with other coagulation molecular markers DD,FDP,TM,and t-PAIC,it can improve the diagnosis rate of the early stage of postoperative DVT in orthopedic patients,providing the best time for clinical early intervention and treatment.