血清microRNA-374b-5p水平预测多发性创伤患者下肢深静脉血栓风险的价值

The value of serum miR-374b-5p level in predicting the risk of lower extremity deep vein thrombosis in patients with multiple trauma

目的探究血清microRNA-374b-5p(miR-374b-5p)水平对多发性创伤患者并发下肢深静脉血栓(DVT)的价值。方法选取2020年1月—2021年12月在海南医学院第二附属医院就诊的192例多发伤患者作为研究对象。根据是否并发下肢DVT将多发伤并发DVT患者作为DVT组、多发伤非DVT患者作为对照组,分别有63、129例。比较两组患者年龄、性别、体重指数(BMI)等人口统计学指标,分析D-二聚体(D-Dimer)、纤维蛋白原(FIB)、纤维蛋白原降解产物(FDP)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及血小板计数(PLT)等凝血指标。通过实时荧光定量聚合酶链反应检测两组患者血清miR-374b-5p的表达,分析其与各临床指标的相关性。通过多因素Logistic回归分析血清miR-374b-5p是否为多发伤并发DVT的独立危险因素。绘制受试者工作特征(ROC)曲线分析miR-374b-5p对多发伤患者并发DVT的预测效能。结果DVT组ISS评分、下肢骨折占比、D-Dime较对照组高(P<0.05)。DVT组血清miR-374b-5p相对表达量较对照组高(P<0.05)。miR-374b-5p高表达组有下肢骨折、FDP较miR-374b-5p低表达组高(P<0.05)。多因素Logistic回归分析结果显示:ISS[OR=1.123(95%CI:1.031,1.223)]、D-Dimer[OR=1.193(95%CI:1.061,1.340)]及miR-374b-5p[OR=1633.912(95%CI:142.683,18710.451)]水平是多发伤并发DVT的影响因素(P<0.05)。ROC曲线分析结果显示,miR-374b-5p的AUC、敏感性最高,分别为0.901(95 CI:0.839,0.963)、84.1%(95 CI:0.714,0.900),D-Dimer的特异性最高,为100.0%(95 CI:0.971,1.000)。结论血清miR-374b-5p水平>1.22时可辅助用于预测多发伤并发DVT的风险,且预测效能优于D-Dimer。

Objective To explore the predictive value of serum miR-374b-5p level in the occurrence of lower extremity deep vein thrombosis(DVT)in patients with multiple trauma.Methods A total of 192 patients with multiple trauma treated in our hospital from January 2020 to December 2021 were selected.According to the presence of lower extremity DVT,they were divided into DVT group(multiple trauma complicated with DVT)and control group(multiple trauma without DVT),with 63 and 129 cases in the two groups,respectively.Demographic characteristics such as age,sex,and body mass index(BMI)were compared between the two groups.The levels of D-dimer,fibrinogen(FIB),fibrinogen degradation products(FDP),prothrombin time(PT),activated partial thromboplastin time(APTT)and platelet count(PLT)were analyzed.The expression of miR-374b-5p in serum of two groups of patients was detected by quantitative real-time polymerase chain reaction(qRT-PCR),and its correlations with clinical indicators were determined.Multivariable Logistic regression analysis was used to investigate whether serum miR-374b-5p level was an independent risk factor for multiple trauma complicated with DVT.The diagnostic value of miR-374b-5p for multiple trauma complicated with DVT was explored via receiver operating characteristic(ROC)curve analysis.Results The ISS,the frequency of lower extremity fractures,and the level of D-dimer in the DVT group were higher than those in the control group(P<0.05).The relative serum expression of miR-374b-5p in the DVT group was higher than that in the control group(P<0.05).The frequency of lower extremity fractures and the level of FDP in patients with high expression of miR-374b-5p were higher than those in patients with low expression of miR-374b-5p(P<0.05).Multivariable Logistic regression analysis revealed that ISS[O^R=1.123(95%CI:1.031,1.223)],the level of D-dimer[O^R=1.193(95%CI:1.061,1.340)]and the expression of miR-374b-5p[O^R=1633.912(95%CI:142.683,18710.451)]were factors affecting the complication of DVT in patients with multiple trauma.ROC curve analysis demonstrated that the sensitivity and the area under the ROC curve(AUC)of miR-374b-5p for diagnosing multiple trauma complicated with DVT were the highest,with them being 0.901(95%CI:0.839,0.963)and 0.841(95%CI:0.714,0.900),respectively.In contrast,the specificity of D-dimer was the highest,being 1.000(95%CI:0.971,1.000).Conclusions Serum miR-374b-5p level is independently correlated with the complication of DVT in patients with multiple trauma,and it may predict the occurrence of multiple trauma complicated with DVT with the cut-off greater than 1.22,the performance of which is even better than that of D-dimer.