血清P选择素、AKP、APCR联合检测对下肢创伤骨折术后深静脉血栓的临床价值研究

Clinical value of combined detection of serum P-selectin,AKP and APCR for deep vein thrombosis after lower extremity traumatic fractures

目的 探讨血清P选择素、碱性磷酸酶(alkaline phosphatase,AKP)、活化蛋白C抗体(activated protein C antibody,APCR)联合检测对下肢创伤骨折术后深静脉血栓(deep vein thrombosis,DVT)的诊断价值。方法 选取2020年10月至2021年11月我院收治的104例下肢创伤骨折患者,按《深静脉血栓形成的诊断和治疗指南(第三版)》中DVT的诊断标准将患者分为DVT组(n=18)和无DVT组(n=86)。测定两组P选择素、AKP、APCR水平,并采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(AUC)分析各参数的诊断价值。结果 两组性别、年龄、发病至手术时间、骨折类型、吸烟率比较差异无统计学意义(P> 0.05);术前、术后1天、术后3天,DVT组血清P选择素、APCR、AKP阳性率均明显高于DVT组(P <0.05);且术后1天、术后3天,两组血清P选择素、APCR、AKP阳性率均较术前明显升高(P <0.05);P选择素、APCR、AKP单独及联合诊断DVT的AUC值分别为0.866、0.633、0.788、0.904。结论 下肢创伤性骨折术后DVT患者血清P选择素、APCR、AKP呈高表达,同时三者联合检测DVT具有较高的诊断效能,且敏感性、特异性均较高。

Objective To explore the value of combined detection of serum P-selectin,alkaline phosphatase(AKP)and activated protein C antibody(APCR)in the diagnosis of deep vein thrombosis(DVT)after lower extremity traumatic fractures.Methods A cohort of 104 patients with lower limb trauma fracture,admitted to our hospital from October 2020 to November 2021,was selected.All were divided into DVT group(n=18)and non-DVT group(n=86)according to the diagnostic criteria of DVT in the Guidelines for the Diagnosis and Treatment of Deep Vein Thrombosis(3rd edition).The levels of P-selectin,AKP,and APCR in each group were determined,and the area under the receiver operating characteristic(ROC)curve(AUC)was used to analyze the diagnostic value of each parameter.Results There were no significant differences between the two groups in gender,age,time from onset to operation,fracture type and smoking rate(P>0.05).The positive rates of serum P-selectin,APCR,and AKP in the DVT group were apparently higher than those in the non-DVT group before operation,1 day after operation and 3 days after operation.The positive rates of serum P-selectin,APCR,and AKP 1 day and 3 days after operation in the two groups were apparently higher than those before the operation(P<0.05).The AUC values for P-selectin,APCR,and AKP alone and in combination for the diagnosis of DVT were 0.866,0.633,0.788,and 0.904,respectively.Conclusions Serum P-selectin,APCR,and AKP are highly expressed in patients with DVT after lower extremity traumatic fractures,and the combined detection of DVT by the three has high diagnostic efficiency,high sensitivity and specificity.