全膝关节置换术后血清中性粒细胞胞外陷阱水平与深静脉血栓形成的相关性  

The role of postoperative levels of neutrophil extracellular traps in deep vein thrombosis after total knee arthroplasty

作　　者：薛龙[1] 乔梁[1] 陆万里[1] 陈东阳[1] 徐志宏[1] 史冬泉[1] 戴进[1] 姚尧[1] 蒋青[1] 

机构地区：[1]南京大学附属鼓楼医院运动医学与成人重建外科,210008

出　　处：《中华骨科杂志》2016年第7期422-428,共7页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（30973046）

摘　　要：目的探讨全膝关节置换术后中性粒细胞胞外陷阱（neutrophilextracellulartraps，NETs）水平与下肢深静脉血栓形成（deepveinthrombosis，DVT）的相关性。方法采用病例对照研究，收集2014年5月至2015年7月行全膝关节置换术术后发生下肢DVT的患者30例，男7例，女23例；年龄47-82岁，平均（65．9±9．0）岁。从同期行全膝关节置换术术后未发生下肢DVT的患者中随机选取30例作为对照。所有患者均在术前1天、术后第1、3、5天留取血清标本，检测血清NETs水平。结果DVT组术后第1天血清NETs水平为1．598±0．067，高于无DVT组的1．212±0．037，差异有统计学意义（t=7．514，P=0．000）；第3天血清NETs水平为1．305±0．044，高于无DVT组的1．167±0．032，差异有统计学意义（t=2．675，P=0．015）。在NETs预测DVT能力的ROC曲线中，术后第1天和术后第3天血清NETs曲线下面积分别为0．828（95％cI：0．722，0．933，P=0．000）和0．677（95％CI：0．541，0．814，P=0．018）。当术后NETs取1．294时，其阳性预测值为80％、阴性预测值为80％、敏感度为80％、特异度为80％。Logistic多因素回归分析中，术后第1天NETs水平是全膝关节置换术后下肢DVT的独立危险因素（0R=24．08，95％CI：4．94，117．28，P=0．000）。结论术后NETs水平与全膝关节置换术后下肢DVT具有相关性。术后NETs水平或许可以作为一个潜在的生物学标志物，用于全膝关节置换术后下肢DVT的早期筛查。Objective To investigate the role of circulating neutrophil extracellular trap （NET） levels in the postoperative formation of deep vein thrombosis （DVT） in patients undergoing total knee arthroplasty （TKA）. Methods Circulating NET levels were measured preoperatively and on postoperative days 1, 3, and 7 in 30 patients diagnosed with DVT by venography after TKA and 30 controls from May 2014 to July 2015. Results In patients with DVT, the mean circulating NET levels were significantly higher on postoperative days 1 and 3 compared with those in the non-DVT group （postoperative day 1, 1.598±0.067 vs. 1.212＋_ 0.037, t=7.514, P=0.000; postoperative day 3, 1.305±0.044 vs. 1.167_＋0.032, t=2.675, P=0.015）. ROC curve analysis revealed the inferior sensitivity and specificity of NET levels on postoperative day 3 compared with postoperative day 1. Area under the curve （AUC） postoperative day 1 was 0.828 （95%CI： 0.722, 0.933, P=0.000）; AUC postoperative day 3 was 0.677 （95%CI： 0.541, 0.814, P=0.018）. The cutoff point for NET levels on postoperative day 1 was 1.294, with a sensitivity of 80%, a specificity of 80%, a positive predictive value of 80%, and a negative predictive value of 80%. After Logistic regression, the NET level on postoperative day 1 was considered an independent predictor of DVT （OR： 24.08, 95%CI： 4.94, 117.28, P=0.000）. Conclusion High circulating NET levels are associated with DVT in patients who undergo TKA. NETs may serve as a potential biological marker to delineate patients undergoing TKA who are most at risk for DVT.

关 键 词：关节成形术 置换 膝 静脉血栓形成 中性白细胞 

分 类 号：R687.4[医药卫生—骨科学]