血浆多种纤溶生物标志物与创伤性下肢骨折术前继发深静脉血栓形成的关系

Correlation between plasma fibrinolytic biomarkers and preoperative deep vein thrombosis after traumatic lower extremity fractures

目的研究血浆多种纤溶生物标志物与创伤性下肢骨折患者术前继发深静脉血栓形成(deep vein thrombosis,DVT)的相关性。方法回顾性收集2019年12月至2021年5月西安交通大学医学院附属红会医院创伤骨科收治的329例创伤性下肢骨折患者的临床资料。患者根据是否发生DVT分为DVT组(43例)和非DVT组(286例),纳入同时期健康志愿者80例作为对照组。在影像学检查前利用纤溶电位测定法检测溶解电位(lysis potential,LP)、溶解时间(lysis time,LT),测量并比较各组的血细胞计数、常规凝血试验、组织纤溶酶原激活剂抑制剂复合物(tissue plasmin activator inhibitor complex,tPAIC)等实验室参数指标。结果非DVT组患者LP和LT高于DVT组和对照组(P<0.05)。DVT组患者国际标准化比率(international standardization ratio,INR)、纤维蛋白原(fibrinogen,FIB)、D-二聚体和tPAIC水平均高于非DVT组患者(P<0.05)。多因素Logistic回归分析结果显示,LP(OR=0.005,P<0.001)和LT(OR=0.475,P=0.002)的降低、血浆FIB(OR=1.003,P=0.006)和tPAIC(OR=1.461,P<0.001)水平升高与DVT风险增加相关。联合检测LP、LT、FIB和tPAIC的受试者工作特征曲线下面积为0.842。结论联合检测LP、LT、FIB、tPAIC有望成为创伤性下肢骨折后继发DVT的辅助诊断指标。

Objective To investigate the correlation between plasma fibrinolytic biomarkers and preoperative deep vein thrombosis(DVT)after traumatic lower extremity fractures.Methods The clinical data of 329 cases of traumatic lower extremity fractures admitted to the Department of Orthopedic Trauma,Honghui Hospital affiliated Xi’an Jiaotong University College of Medicine from December 2019 to May 2021 were enrolled retrospectively.According to whether secondary DVT had occurred,patients were divided into DVT group(43 cases)and non-DVT group(286 cases).In addition,80 healthy volunteers in the same period were included as control group.The lysis potential(LP)and lysis time(LT)were measured by fibrinolysis potential assay before imaging examination.Other laboratory parameters included blood cell counts,conventional coagulation tests,tissue plasminogen activator inhibitor complex(tPAIC)were measured and compared.Results LP and LT in non-DVT group were higher than those in DVT group and control group(P<0.05).In addition,the levels of international standardization ratio(INR),fibrinogen(FIB),D-dimer and tPAIC in DVT group were higher than those in non-DVT group(P<0.05).Multivariate Logistic regression analysis showed that the decrease of LP(OR=0.005,P<0.001)and LT(OR=0.475,P=0.002),and the increase of FIB(OR=1.003,P=0.006)and tPAIC(OR=1.461,P<0.001)were associated with the increased risk of DVT.The area under the receiver operating characteristic curve was 0.842 for combined detection of LP,LT,FIB and tPAIC.Conclusion The combined detection of LP,LT,FIB and tPAIC is expected to become an auxiliary diagnostic indicator for secondary DVT after traumatic lower limb fractures.