血清sCD40L、ADAMTS13与老年髋部骨折患者术后下肢深静脉血栓形成的关系

Relationship between serum sCD40L,ADAMTS13 and postoperative lower extremity deep vein thrombosis in elderly patients with hip fractures

目的 探讨血清可溶性细胞表面分化抗原40配体(sCD40L)、血管性血友病因子裂解蛋白酶13(ADAMTS13)水平与老年髋部骨折患者术后下肢深静脉血栓(DVT)形成的关系。方法 选取2022年6月至2023年6月在该院就诊的192例老年髋部骨折患者,根据其术后是否发生下肢DVT分为非DVT组(120例)和DVT组(72例)。酶联免疫吸附试验检测各组血清sCD40L、ADAMTS13水平;Pearson法分析患者血清sCD40L与ADAMTS13水平的相关性;多因素Logistic回归模型分析影响老年髋部骨折患者术后发生下肢DVT的因素;受试者工作特征(ROC)曲线评估血清sCD40L、ADAMTS13水平对老年髋部骨折患者术后发生下肢DVT的预测价值。结果 两组高脂血症占比及骨折至开始手术时间比较,差异有统计学意义(P<0.05)。与非DVT组比较,DVT组血清sCD40L水平升高(P<0.05),ADAMTS13水平降低(P<0.05);Pearson法分析结果显示,患者血清sCD40L水平与ADAMTS13水平呈负相关(r=-0.457,P<0.001);多因素Logistic回归模型分析结果显示,高脂血症、骨折至开始手术时间长、血清sCD40L水平升高是老年髋部骨折患者术后发生下肢DVT的危险因素(P<0.05);血清ADAMTS13水平升高是影响老年髋部骨折患者术后发生下肢DVT的保护因素(P<0.05)。血清sCD40L、ADAMTS13联合预测老年髋部骨折患者术后发生下肢DVT的曲线下面积为0.812,大于sCD40L和ADAMTS13单独预测(P<0.05)。结论 老年髋部骨折术后发生下肢DVT患者血清sCD40L水平升高,ADAMTS13水平降低,二者水平可反映DVT的发生风险,且对老年髋部骨折患者发生下肢DVT具有一定的预测价值。

Objective To explore the relationship between serum soluble cell surface differentiation antigen 40 ligand(sCD40L),a disintegrin-like and metalloproteinase with thrombospondin type-1 motif 13(ADAMTS13)levels and postoperative lower extremity deep vein thrombosis(DVT)formation in elderly patients with hip fractures.Methods A total of 192 elderly patients with hip fractures who visited the hospital from June 2022 to June 2023 were selected and separated into non DVT group(120 cases)and DVT group(72 cases)based on whether they experienced lower extremity DVT after surgery.Enzyme-linked immunosorbent assay was applied to detect serum sCD40L and ADAMTS13 levels in each group.Pearson method was applied to analyze the correlation between serum sCD40L and ADAMTS13 levels in patients.Multivariate Logistic regression model was applied to analyze the factors affecting postoperative lower extremity DVT in elderly patients with hip fractures.Receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of serum sCD40L and ADAMTS13 levels for postoperative lower extremity DVT in elderly patients with hip fractures.Results There were statistically significant differences in the proportion of hyperlipidemia and the time from fracture to surgery between the two groups(P<0.05).Compared with the non DVT group,the serum sCD40L level in the DVT group increased(P<0.05)and the ADAMTS13 level decreased(P<0.05).Pearson method results showed that the serum sCD40L level was negatively correlated with ADAMTS13 level in patients(r=-0.457,P<0.001).Multivariate Logistic regression model analysis showed that hyperlipidemia,long time from fracture to surgery,increased level of serum sCD40L were risk factors for postoperative lower extremity DVT in elderly patients with hip fractures(P<0.05),and the increased level of serum ADAMTS13 was a protective factor for postoperative lower extremity DVT in patients with hip fractures(P<0.05).The area under the curve of the combined prediction of serum sCD40L and ADAMTS13 for postoperative lower extremity DVT in elderly patients with hip fractures was 0.812,which was larger than that of sCD40L and ADAMTS13 alone(P<0.05).Conclusion Serum sCD40L level increases and ADAMTS13 level decreases in elderly patients with hip fracture who had lower extremity DVT after surgery,the two could reflect the risk of DVT and have predictive value for the occurrence of lower extremity DVT in elderly patients with hip fracture.