高同型半胱氨酸血症对骨科术后深静脉血栓发生的影响  

Effect of hyperhomocysteinemia on deep vein thrombosis after orthopedic surgery

作　　者：张磊[1] 李引刚 崔志强 陈楚 马建兵 支力强 ZHANG Lei;LI Yingang;CUI Zhiqiang;CHEN Chu;MA Jianbing;ZHI Liqiang(Shanxi University of Traditional Chinese Medicine,Xianyang 712000,Shanxi,China;The Affiliated Hospital of Shanxi University of Traditional Chinese Medicine,Xianyang 712000,Shanxi,China;Xi'an Honghui Hospital,Xi'an 710000,China)

机构地区：[1]陕西中医药大学,陕西咸阳712000 [2]陕西中医药大学附属医院,陕西咸阳712000 [3]西安市红会医院,陕西西安710000

出　　处：《西部医学》2020年第10期1500-1503,共4页Medical Journal of West China

基　　金：中国博士后科学基金(2017M623215);西安市科技局项目(2019114613YX00ISF037)。

摘　　要：目的探讨高同型半胱氨酸血症与骨科术后深静脉血栓(DVT)发生的相关性。方法回顾性分析2018年1月~2019年4月在西安市红会医院就诊的149例骨科术后行DVT探查患者的临床资料,根据患者术前同型半胱氨酸(Hcy)水平分为高同型半胱氨酸组和正常组;再根据术后超声结果分为DVT组(术前无-术后有)和非DVT组(术前无-术后无),排除术前有血栓患者。比较各组之间Hcy值的差异,评价DVT与HHcy的关系,再进一步评价HHcy对发生DVT的预测价值,并分析两者间的相关性。结果各组之间年龄、性别比较无统计学意义(P>0.05);DVT亚组分析DVT组Hcy值(24.7±14.2)μmol/L与非DVT组(14.8±6.7)μmol/L存在明显差异(P<0.001),但Hcy数值与血栓宽度无统计学意义(P=0.553);在DVT组分析中HHcy者发生率高于正常Hcy者(81.2%vs 18.8%)(P<0.001);分析显示DVT的发生与Hcy水平存在显著性相关(P<0.001),ROC曲线分析显示HHcy对骨科术后DVT的预测有较好的诊断价值(AUC 0.750);采用logistic回归分析,Hcy为自变量,DVT是否发生为因变量,得Exp(B)即OR为5.385,P<0.05,可得HHcy与术后DVT发生存在相关性。结论高同型半胱氨酸血症对增加骨科手术后深静脉血栓的发生率有影响,两者存在相关性,但同型半胱氨酸的数值与血栓宽度直径无明显相关性,高同型半胱氨酸血症可以作为预测骨科术后DVT的诊断标志物之一。Objective To investigate the effect of hyperhomocysteine on deep vein thrombosis(DVT)after orthopedic surgery.Methods The clinical data of 149 orthopedic patients who underwent DVT in Xi’an Honghui Hospital from January 2018 to April 2019 were retrospectively analyzed.According to the preoperative homocysteine(Hcy)level,the patients were divided into high homocysteine group and normal group.According to the postoperative ultrasound results,they were divided into DVT group(preoperative no postoperative)and non DVT group(preoperative none postoperative),excluding preoperative blood Thrombus patients.The difference of Hcy value between each group was compared.The relationship between DVT and HHcy was evaluated.The predictive value of HHcy for DVT occurrence was further evaluated,and the correlation between them was analyzed.Results Among the 149 patients,68 were male and 81 were female,69 were DVT patients,54 were non-DVT patients,97 were HHcy patients,and 52 were normal Hcy patients.Age and gender were not statistically significant between the groups(P>0.05).In the subgroup analysis of DVT,there was a significant difference in Hcy value(24.7±14.2)mol/L between DVT group and non-DVT group(14.8±6.7)(P<0.001),but there was no statistical significance between Hcy value and thrombus width(P=0.553).The incidence of the HHcy group was higher than that in the normal Hcy group(81.2%vs 18.8%)(P<0.001).DVT was significantly correlated with Hcy level(P<0.001).ROC curve analysis showed that HHcy had good accuracy in predicting DVT after orthopaedic surgery(AUC 0.750).Logistic regression analysis showed that Hcy was the independent variable and the occurrence of DVT was the dependent variable.Exp(B),OR was 5.385,P=0.000<0.05,which suggested that HHcy was correlated with the occurrence of postoperative DVT.Conclusion Hyperhomocysteinemia has an effect on the incidence of DVT after orthopedic surgery,and there is a correlation between the two,but the value of homocysteine has no obvious correlation with the width and diameter

关 键 词：同型半胱氨酸 骨科手术 深静脉血栓 高同型半胱氨酸血症 

分 类 号：R619.2[医药卫生—外科学]