多配体蛋白聚糖-1联合传统凝血指标对颅脑创伤患者早期下肢深静脉血栓发生风险的预测价值

The predictive value of multi⁃ligand proteoglycan⁃1 on the risk of lower limb deep vein thrombosis in patients with traumatic brain injury in early stage after surgery

目的分析多配体蛋白聚糖-1(SYN-1)对创伤性颅脑损伤(TBI)患者术后早期发生下肢深静脉血栓(DVT)风险预测价值。方法回顾性分析郑州大学附属郑州中心医院重症医学科2018年01月至2021年06月收治的178例TBI患者术后7 d内临床资料,根据是否发生DVT分为观察组(发生DVT)和对照组(未发生DVT),单因素比较两组患者临床资料,多因素Logistic回归分析TBI患者术后早期发生下肢DVT危险因素。结果经过调查178例TBI患者中,发生DVT人数96例(53.93%)。单因素比较结果显示,观察组的年龄、格拉斯哥昏迷量表(GCS)评分、纤维蛋白原降解产物(FDP)、D二聚体(D-D)、血小板计数(PLT)及SYN-1表达均显著高于对照组(P<0.05)。多因素Logistic分析结果显示,GCS评分、FDP、D-D、PLT和SYN-1均是TBI患者术后早期发生下肢DVT的独立危险因素(P<0.05)。ROC曲线分析结果显示,SYN-1对术后早期发生下肢DVT风险预测效能AUC为0.782(0.714~0.850),特异性为0.890,敏感度为0.615,YI为0.505,最佳截断值为39.15 ng/mL,预测效能优于FDP,略差于D-D、GCS评分和PLT。结论TBI患者术后早期内发生DVT风险较高,SYN-1、D-D、GCS评分、FDP和PLT均是TBI患者术后早期发生下肢DVT的显著危险因素,SYN-1对术后早期发生下肢DVT预测效能相对理想。

Objective To analyze the predictive value of syndecan-1(SYN-1)in predicting the risk of lower limb deep vein thrombosis(DVT)in patients with traumatic brain injury(TBI)in early stage after surgery.Methods Regression analysis was conducted on the clinical data of 178 TBI patients admitted to the Department of Critical Care of Zhengzhou Central Hospital affiliated to Zhengzhou University from January 2018 to June 2021 within 7 days after surgery.They were divided into an observation group(with DVT)and a control group(without DVT)based on whether DVT occurred.The clinical data of the two groups were compared with univariate analysis,and the risk factors for lower limb DVT in TBI patients were analyzed using multivariate logistic regression.Results 96 out of 178 TBI patients(53.93%)developed DVT.Univariate comparison showed that the age,Glasgow Coma Scale(GCS)score,fibrinogen degradation products(FDP),D-dimer(D-D),platelet count(PLT),and SYN-1 level of TBI patients with lower limb DVT were significantly higher than those without lower limb DVT(P<0.05).Multivariate logistic analysis showed that GCS score,FDP,D-D,PLT,and SYN-1 were all significant risk factors for lower limb DVT in TBI patients in early stage(P<0.05).The ROC curve analysis showed that the predictive efficacy of SYN-1 for the risk of lower limb DVT in TBI patients was 0.782(0.714~0.850),with a specificity of 0.890,a sensitivity of 0.615,a YI of 0.505,and an optimal cutoff value of 39.15 ng/mL.The predictive efficacy was superior to FDP,but slightly inferior to D-D,GCS scores,and PLT.Conclusions TBI patients have a higher risk of developing lower limb DVT in early stage after surgery.SYN-1,D-D,GCS scores,FDP,and PLT are all significant risk factors for developing lower limb DVT in TBI patients.SYN-1 has a relatively ideal predictive value for the occurrence of lower limb DVT.