血清基质金属蛋白酶-1与基质金属蛋白酶-2水平与下肢骨折手术患者术后下肢深静脉血栓形成的相关性分析

Correlation analysis of serum MMP-1 and MMP-2 levels with lower extremity deep venous thrombosis after operation for lower limb fracture

目的:探讨血清基质金属蛋白酶-1(matrix metalloproteinase-1,MMP-1)、基质金属蛋白酶-2(matrix metalloproteinase-2,MMP-2)与下肢骨折手术患者术后下肢深静脉血栓(lower extremity deep venous thrombosis,LDVT)形成的关系,分析MMP-1、MMP-2预测下肢骨折术后发生LDVT的价值。方法:选择2018年6月至2021年12月拟行下肢骨折手术治疗的352例患者为研究对象,分别于术后1、2、3d采集静脉血,检测血清MMP-1、MMP-2水平,并统计住院期间LDVT发生情况,分析下肢骨折手术患者术后LDVT发生的危险因素以及MMP-1、MMP-2预测LDVT发生的价值。结果:40例发生LDVT,312例未发生LDVT。发生LDVT患者术后血清MMP-1、MMP-2水平逐渐增高,未发生组术后2 d血清MMP-1、MMP-2水平小幅增高后于术后3 d下降(P<0.01),发生LDVT组术后2、3 d血清MMP-1、MMP-2水平高于未发生组(P<0.05)。发生LDVT患者术后2、3 d血清MMP-1、MMP-2水平与血清白细胞介素(interleukin,IL)-6、IL-8和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平均呈正相关(P<0.05)。手术时间、术后3d MMP-1、MMP-2与下肢骨折术后发生LDVT有关(P<0.01)。术后3 d的MMP-1、MMP-2预测下肢骨折术后LDVT的曲线下面积(area under curve,AUC)分别为0.738、0.744,联合预测的曲线下面积为0.910,高于单独指标预测(Z=2.819、2.025,P<0.05)。结论:下肢骨折术后高水平MMP-1、MMP-2与LDVT的发生密切相关,术后3 d的MMP-1、MMP-2也许可作为LDVT风险预测的评估指标。

Objective To investigate the relationship between serum matrix metalloproteinase-1(MMP-1)and matrix metalloproteinase-2(MMP-2)and the formation of deep venous thrombosis(LDVT)in lower extremity patients after surgery for lower extremity fracture,and to analyze the value of MMP-1 and MMP-2 in predicting the occurrence of LDVT after lower extremity fracture.Methods From June 2018 to December 2021,352 patients who planned to receive surgical treatment of lower limb fracture in our hospital were selected as the research objects.Venous blood was collected at 1,2 and 3 days after surgery,respectively,and serum MMP-1 and MMP-2 levels were detected.The incidence of LDVT during hospitalization was analyzed,and the risk factors of postoperative LDVT in patients with lower limb fracture surgery and the predictive value of MMP-1 and MMP-2 for LDVT were analyzed.Results LDVT occurred in 40 patients(LDVT group),the incidence of LDVT was 11.36%,and 312 patients did not occurred(no occurred group).The serum levels of MMP-1 and MMP-2 in LDVT group increased gradually after surgery;the serum levels of MMP-1 and MMP-2 in the no occurred group increased slightly after surgery at 2 days and then decreased at 3 days after surgery(P<0.01);the serum levels of MMP-1 and MMP-2 in LDVT group were higher than those in the no occurred group at 2 days and 3 days after surgery(P<0.05).Serum levels of MMP-1 and MMP-2 were positively correlated with serum levels of interleukin-6(IL-6),IL-8 and tumor necrosis factor-α(TNF-α)in LDVT patients at 2 days and 3 days postoperatively(P<0.05).Operative time,MMP-1 and MMP-2 postoperative 3 days were related to the occurrence of LDVT after lower limb fracture(P<0.01).The area under the curve(AUC)predicted by MMP-1 and MMP-2 postoperative 3 days for LDVT after lower limb fracture was 0.738 and 0.744 respectively,and the AUC predicted by combined MMP-1 and MMP-2 was 0.910,which was higher than that predicted by single indicator(Z-2.819 and 2.025,P<0.05).Conclusion High levels of MMP-1 and MMP-2 after lower extremity fracture are closely related to the occurrence of LDVT,and 3 d mMP-1 and MMP-2 after surgery maybe used as evaluation indexes for LDVT risk prediction.