Diagnostic Value of the Padua Score Combined with Thrombotic Biomarker Tissue Plasminogen Activator Inhibitor-1 (tPAI-1) Detection for the Risk of Deep Vein Thrombosis in Patients with Pulmonary Heart Disease

This study explores the diagnostic value of combining the Padua score with the thrombotic biomarker tissue plasminogen activator inhibitor-1(tPAI-1)for assessing the risk of deep vein thrombosis(DVT)in patients with pulmonary heart disease.These patients often exhibit symptoms similar to venous thrombosis,such as dyspnea and bilateral lower limb swelling,complicating differential diagnosis.The Padua Prediction Score assesses the risk of venous thromboembolism(VTE)in hospitalized patients,while tPAI-1,a key fibrinolytic system inhibitor,indicates a hypercoagulable state.Clinical data from hospitalized patients with cor pulmonale were retrospectively analyzed.ROC curves compared the diagnostic value of the Padua score,tPAI-1 levels,and their combined model for predicting DVT risk.Results showed that tPAI-1 levels were significantly higher in DVT patients compared to non-DVT patients.The Padua score demonstrated a sensitivity of 82.61%and a specificity of 55.26%at a cutoff value of 3.The combined model had a significantly higher AUC than the Padua score alone,indicating better discriminatory ability in diagnosing DVT risk.The combination of the Padua score and tPAI-1 detection significantly improves the accuracy of diagnosing DVT risk in patients with pulmonary heart disease,reducing missed and incorrect diagnoses.This study provides a comprehensive assessment tool for clinicians,enhancing the diagnosis and treatment of patients with cor pulmonale complicated by DVT.Future research should validate these findings in larger samples and explore additional thrombotic biomarkers to optimize the predictive model.

急性肺动脉血栓栓塞PAI-1启动子区插入／缺失多态性研究

目的研究急性肺动脉血栓栓塞（APTE）患者纤溶酶原激活物抑制物-1（PAI-1）启动子区插入／缺失多态性。方法根据是否合并下肢静脉血栓将58例APTE患者分为2组：合并下肢深静脉血栓组（37例），未合并下肢深静脉血栓组（21例）；选择正常对照者57例。采用聚合酶链反应一限制性片段长度多态性法测定PAI-1插入，缺失多态性。结果病例组中4G纯合子基因型频率显著高于对照组，4G纯合子、4G／5G杂合子及5G纯合子3种基因型频率在病例组与对照组间有显著性差异；病例组4G等位基因频率显著高于对照组，4G和5G等位基因频率在病例组与对照组间有显著性差异。未合并下肢深静脉血栓组4G纯合子基因型显著高于合并下肢深静脉血栓组和正常对照组（均P=0．04），而合并下肢深静脉血栓组与正常对照组比较无显著差异。结论PAI-1启动子区插入／缺失多态性与APTE有关，4G纯合子基因型显著增加未合并下肢静脉血栓个体的肺栓塞风险。

组织型纤溶酶原激活物及其抑制物与静脉血栓栓塞症的关系

目的探讨组织型纤溶酶原激活物(t-PA)及其抑制物-1(PAI-1)血浆水平与静脉血栓栓塞症的关系。方法 87例肺动脉血栓栓塞(PTE)患者,根据是否合并深静脉血栓形成(DVT)分为2组:合并DVT患者52例,未合并DVT患者35例,同期入选性别、年龄匹配对照者80例。酶联免疫吸附试验测定血浆PAI-1和t-PA水平,聚合酶链反应-限制性片段长度多态性法检测PAI-1基因型。结果未合并DVT组t-PA明显降低,PAI-1明显升高,与合并DVT组、对照组比较差别有统计学意义(P<0.05),而合并DVT组与对照组比较差别无统计学意义(P>0.05)。在3组中,无论何种基因型,未合并DVT组的PAI-1血浆水平均最高。在4G/4G基因型和4G/5G基因型中,未合并DVT组与对照组和合并DVT组比较差别均有统计学意义(P<0.05)。结论未合并DVT的PTE患者存在明显的低纤溶状态。