急性下肢骨折合并下肢深静脉血栓形成患者凝血功能和血栓分子标志物的对比分析

Comparative analysis of coagulation function and thrombus molecular markers in patients with acute fracture and lower extremity deep venous thrombosis

目的对比凝血功能检查和血栓分子标志物检查在急性下肢骨折合并下肢深静脉血栓形成(DVT)诊断中的应用价值。方法收集2020年6月至2021年6月北京积水潭医院收治的204例下肢骨折患者的临床资料,所有患者均进行了下肢静脉造影检查,并根据是否发生下肢DVT分为血栓组和非血栓组,每组102例。比较两组患者的血栓分子标志物[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抑制物复合物(t PAI-C)、血栓调节蛋白(TM)]水平,分析急性下肢骨折合并下肢DVT患者血浆中血栓分子标志物水平与常规凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体水平、纤维蛋白降解产物(FDP)]的相关性,评估血栓分子标志物对急性下肢骨折合并下肢DVT的诊断效能。结果血栓组患者血浆中的TAT、PIC水平均明显高于非血栓组患者(P﹤0.01)。相关性分析结果显示,血栓组患者血浆中的TAT水平与PT、APTT均呈负相关(r=-0.173、-0.209,P﹤0.05),与D-二聚体、FIB、FDP水平均呈正相关(r=0.344、0.152、0.331,P﹤0.05);PIC水平与D-二聚体、FIB、FDP水平均呈正相关(r=0.512、0.391、0.534,P﹤0.01);t PAI-C水平与FDP水平呈正相关(r=0.161,P=0.001);TM与D-二聚体、FDP水平均呈正相关(r=0.162、0.148,P﹤0.05)。t PAI-C诊断急性下肢骨折合并下肢DVT的特异度最高,约登指数、曲线下面积(AUC)最大,对DVT的鉴别诊断效能最高。结论急性下肢骨折合并下肢DVT患者血浆中的血栓分子标志物水平与常规凝血功能指标显著相关,但一致性较差。t PAI-C对急性下肢骨折合并下肢DVT具有良好的辅助诊断价值。

Objective To compare the application value of coagulation test and thrombus molecular markers in patients with acute lower extremity fracture and lower extremity deep venous thrombosis(DVT).Method Clinical data of 204 patients with lower extremity fracture in Beijing Jishuitan Hospital from June 2020 to June 2021 were collected.All patients received lower extremity veinography and were divided into the thrombosis group and non-thrombosis group according to occurrence of lower extremity DVT,with 102 cases in each group.The thrombus molecular markers[thrombin-antithrombin complex(TAT),plasmin-α2-plasmin inhibitor complex(PIC),tissue-type plasminogen activator-inhibitor complex(tPAI-C),thrombomodulin(TM)]were compared between the two groups of patients,the correlation of thrombus molecular markers levels with conventional coagulation function indicators[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-dimer,fibrin degradation product(FDP)]in patients with acute lower extremity fracture and lower extremity DVT were analyzed and the diagnostic efficiency of thrombus molecular markers in acute lower extremity fracture and lower extremity DVT were evaluated.Result The TAT and PIC in the plasma of patients in the thrombosis group were significantly higher than those in non-thrombosis group(P<0.01).Correlation analysis showed TAT in the plasma of patients in thrombosis group was negatively correlated with PT and APTT(r=-0.173,-0.209,P<0.05),while positively correlated with D-dimer,FIB and FDP(r=0.344,0.152,0.331,P<0.05).PIC was positively correlated with D-dimer,FIB and FDP(r=0.512,0.391,0.534,P<0.01).The tPAI-C were positively correlated with FDP(r=0.161,P=0.001),and TM was positively correlated with D-dimer and FDP(r=0.162,0.148,P<0.05).The specificity of tPAI-C in the diagnosis of DVT in patients with acute lower extremity fracture were highest,with the highest Youden index,area under the curve(AUC)and diagnostic efficiency for DVT.Conclusion The levels of thrombus molecular markers in plasma of patients with acute lower extremity fractures and lower extremity DVT were significantly correlated with conventional coagulation function indicators,but the consistency was poor.tPAI-C has a good auxiliary diagnostic value for acute lower extremity fractures and lower extremity DVT.