FⅪ和FⅫ在VTE血栓稳定性中的作用及预防PE的临床研究

Clinical Study on the Role of FⅪ and FⅫ in VTE Thrombus Stability and Prevention of PE

目的探讨凝血因子Ⅻ(FactorⅫ,FⅫ)、凝血因子Ⅺ(FactorⅪ,FⅪ)在静脉血栓栓塞症(Venous Thromboembolism,VTE)血栓稳定性中的作用,并评估预防肺血栓栓塞症(Pulmonary Embolism,PE)的临床效果。方法采用随机对照试验设计,选取2023年1—12月河西学院附属张掖人民医院共300例VTE患者,根据我国深静脉血栓形成(Deep Vein Thrombosis,DVT)及PE的诊断与治疗指南,将患者分为对照组(单纯DVT组,250例)与观察组(DVT合并PE组,50例)。检验两组患者全身静脉血及下肢深静脉血栓局部FⅫ和FⅪ的活性;同时,针对观察组,比较不同危险程度PE患者中FⅫ和FⅪ的活性。绘制受试者工作特征(Receiver Operating Characteristic,ROC)曲线,分析FⅫ和FⅪ对DVT合并PE患者的评估价值。结果观察组全身静脉血中FⅫ和FⅪ活性明显高于对照组,差异有统计学意义(P均<0.05)。观察组下肢深静脉血栓局部血液中FⅫ[(130.89±0.16)%]和FⅪ[(120.35±0.46)%]活性明显高于对照组[(120.96±0.02)、(112.56±0.49)%],差异有统计学意义(t=950.917、103.637,P均<0.05)。在观察组中,不同危险程度PE患者的FⅪ和FⅫ活性对比,差异有统计学意义(P均<0.05)。FⅫ联合FⅪ针对PE患者的AUC、95%CI、灵敏度、特异度均较高(P均<0.05)。结论FⅫ联合FⅪ可能在VTE血栓稳定性中发挥重要作用,且对于预防PE的发生可能具有潜在临床价值。

Objective To investigate the role of coagulation factorⅫ(FⅫ)and coagulation factorFⅪ(FⅪ)in thromboembolism stability in venous thromboembolism(VTE).Methods A total of three hundred VTE patients in Zhangye People′s Hospital Affiliated to Hexi University from January to December 2023 were select by randomized controlled trial design.According to the diagnosis and treatment guidelines of deep vein thrombosis(DVT)and PE in China,the patients were divided into control group(DVT group alone,250 cases)and observation group(DVT group combined with PE group,50 cases).The activity of systemic venous blood and local FⅫand FⅪ of lower extremity deep vein thrombus in two groups were examined.For the observation group,the activities of FⅫand FⅪin PE patients with different risk levels were compared.Receiver operating characteristics(ROC)curves were drawn to analyze the evaluation value of FⅫand FXI for patients with DVT and PE.Results The activities of FⅫand FⅪin total venous blood of observation group were significantly higher than those of control group,and the differences were statistically significant(both P<0.05).The activities of FⅫ[(130.89±0.16)%]and FⅪ[(120.35±0.46)%]in observation group were significantly higher than those in control group[(120.96±0.02)%、(112.56±0.49)%],and the differences were statistically significant(t=950.917,103.637,both P<0.05).In the observation group,there were statistically significant differences in FⅪand FⅫactivities in PE patients with different risk levels(all P<0.05).FⅫcombined FⅪhad high AUC,95%CI,sensitivity and specificity for PE patients(all P<0.05).Conclusion FⅫcombined FⅪmay play an important role in the thrombotic stability of VTE and may have potential clinical value in preventing the occurrence of PE.