N末端B型钠尿肽前体和脂蛋白(a)水平及凝血功能预测慢性心力衰竭并发深静脉血栓作用

Predictive value of NT-proBNP and Lp(a)levels and coagulation function for deep venous thrombosis in chronic heart failure patients

目的探讨N末端B型钠尿肽前体(NT-proBNP)、脂蛋白(a)[Lp(a)]及凝血功能指标在老年慢性心力衰竭(CHF)并发下肢深静脉血栓(DVT)患者中的表达以及预测价值。方法选取2022年1月25日至12月25日于衡水市人民医院住院治疗的CHF患者230例,根据是否合并DVT分为DVT组76例和非DVT组154例,选取同期健康体检者100例为对照组。收集各组患者一般临床资料、临床指标、凝血功能指标,采用酶联免疫吸附法检测血清NT-proBNP、Lp(a)水平,采用logistic回归分析独立风险因素,采用ROC曲线分析单项和联合检测的预测价值。结果DVT组合并下肢动脉硬化发生率显著高于非DVT组(P<0.05),其他一般资料比较,差异无统计学意义(P>0.05)。DVT组血小板计数、低密度脂蛋白胆固醇高于非DVT组,高密度脂蛋白胆固醇低于非DVT组(P<0.05)。DVT组活化部分凝血活酶时间(aPTT)、凝血酶原时间、凝血酶时间显著低于非DVT组,纤维蛋白原(FIB)、D-二聚体、NT-proBNP、Lp(a)水平显著高于非DVT组,与对照组比较差异有统计学意义(P<0.05)。Logistic回归分析显示,高密度脂蛋白胆固醇、aPTT、FIB、D-二聚体、NT-proBNP、Lp(a)是老年CHF患者并发DVT的独立风险因素(P<0.05,P<0.01),获得logistic回归模型为:logit(P)=0.933X3+0.744X8+0.812X11+0.681X12+0.774X13+0.684X14。Logistic回归模型联合检测ROC曲线下面积为0.948(95%CI:0.918~0.977),敏感性为89.47%,特异性为89.61%。结论NT-proBNP、Lp(a)及凝血功能指标是老年CHF患者并发DVT的独立风险因素,联合检测具有较高的预测价值。

Objective To investigate the predictive value of combined serum levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP)and lipoprotein(a)[Lp(a)]and coagulation function indicators for occurrence of deep venous thrombosis(DVT)in elderly patients with chronic heart failure(CHF).Methods A total of 230 elderly CHF patients admitted in Hengshui People's Hos-pital from January 25 to December 25,2022 were enrolled,and divided intoa DVT group(76 ca-ses)and a non-DVT group(154 cases)based on the presence of DVT or not.And another 100 healthy individuals taking physical examination during the same period were included and served as the control group.The general information,clinical data,and coagulation indicators of each group were collected.Serum NT-proBNP and Lp(a)levels were measured with ELISA.Logistic regression analysis was used to determine the independent risk factors,and ROC curve was used to determine the predictive values of single and combined detection.Results The incidence of lower limb arteriosclerosis was significantly higher in the DVT group than that in the non-DVT group(P<0.05),but there were no statistical differences in other data(P>0.05).Platelet count and LDL in DVT group were higher than those in non-DVT group,and HDL was lower than those in non-DVT group(P<0.05).The DVT group had notably shorter activated partial throm-boplastin time(aPTT),prothrombin time(PT)and thrombin time(TT),and remarkably higher FIB,D-dimer,NT-proBNP and Lp(a)levels when compared with the non-DVT group(P<0.05).Logistic regression analysis showed that HDL,aPTT,FIB,D-dimer,NT-proBNP and Lp(a)were independent risk factors for DVT in elderly CHF patients(P<0.05,P<0.01).The obtained lo-gistic regression model was:Logit(P)=0.933X3+0.744X8+0.812X11+0.681X12+0.774X13+0.684X14.The combined regression model had an AUC value of 0.948(95%CI:0.918-0.977),a sensitivity of 89.47%and a specificity of 89.61%.Conclusion NT-proBNP,Lp(a),and coagula-tion function indicators are independent risk factors for DVT in elderly CHF patients,and com-bined detection has high predictive value.