血栓分子标志物预测下肢骨折患者术后发生静脉血栓栓塞的价值  

The value of thrombus molecular markers in predicting the occurrence of postoperative venous thromboembolism in patients with lower extremity fracture

作　　者：季洪良 闫本纯 郑洋洋 李琪 杨正亮 张钦政 马润瑶 闫海润 JI Hongliang;YAN Benchun;ZHENG Yangyang;LI Qi;YANG Zhengliang;ZHANG Qinzheng;MA Runyao;YAN Hairun(Department of Clinical Laboratory,Hongqi Hospital Affiliated to Mudanjiang Medical College,Mudanjiang,Heilongjiang 157000,China)

机构地区：[1]牡丹江医学院附属红旗医院检验科,黑龙江牡丹江157000

出　　处：《国际检验医学杂志》2020年第20期2514-2517,共4页International Journal of Laboratory Medicine

摘　　要：目的探讨凝血酶-抗凝血酶复合物(TAT)、血栓调节蛋白(TM)、纤溶酶-抗纤溶酶复合物(PIC)、组织型纤溶酶原激活物-抑制剂复合物(t-PAIC)预测下肢骨折患者术后发生静脉血栓栓塞(VTE)的价值。方法选择103例下肢骨折进行手术治疗的患者为研究对象。比较术后发生VTE的患者和未发生VTE的患者血浆TAT、TM、PIC和t-PAIC水平。采用受试者工作特征(ROC)曲线分析TAT、TM、PIC和t-PAIC预测下肢骨折患者术后发生VTE的价值。结果30例患者术后发生VTE(A组),73例患者未发生VTE(B组)。A组患者TM、PIC和t-PAIC水平在术后第1、3、7天较B组患者显著升高(P<0.05)。A组患者TAT在术后第1天高于B组患者(P<0.05)。ROC曲线分析显示,术后第3天联合检测TM、PIC和t-PAIC预测下肢骨折患者术后发生VTE的灵敏度和特异度较高分别为83.3%和93.9%。单独检测时,术后第3天t-PAIC预测下肢骨折患者术后发生VTE的灵敏度和特异度较高,分别为40.0%和90.9%。结论术后第3天检测t-PAIC水平可能是筛查术后是否发生VTE最有用的指标。术后第3天联合检测TM、PIC和t-PAIC对下肢骨折患者术后是否发生VTE的诊断价值最大。Objective The purpose of this study was to analyze and evaluate thrombin-antithrombin complex(TAT),thrombomodulin(TM),plasmin-antiplasmin complex(PIC)and tissue plasminogen activator inhibitory complex(t-PAIC)in predicting the occurrence of postoperative venous thromboembolism(VTE)in patients with lower extremity fractures.Methods A total of 103 patients with lower extremity fractures were selected for surgical treatment.Plasma TAT,TM,PIC,and t-PAIC levels were compared between patients with VTE and those without VTE.The results were analyzed by receiver operating characteristic(ROC)curves to determine the values of TAT,TM,PIC and t-PAIC in diagnosing VTE in patients with lower extremity fractures.Results Thirty patients were diagnosed with VTE(group A)and 73 patients were diagnosed without VTE(group B).The levels of TM,PIC and t-PAIC in patients of group A on the 1st,3rd,and 7th day after surgery were significantly higher than that in patients of group B(P<0.05).Level of TAT of group A on the 1st day after surgery was significantly higher than that of group B(P<0.05).ROC curve analysis showed that the combined detection of TM,PIC and t-PAIC on the 3rd day after surgery had the highest sensitivity(83.3%)and specificity(93.9%)in diagnosing VTE.The sensitivity and specificity of single detection of t-PAIC level were 40.0%and 90.9%,respectively.Conclusion The level of t-PAIC measured on the 3rd day after surgery may be the most useful parameter for screening for postoperative VTE.Combined detection of TM,PIC and t-PAIC on the 3rd postoperative day is the most valuable for the diagnosis of postoperative VTE.

关 键 词：凝血酶-抗凝血酶复合物 血栓调节蛋白 纤溶酶-抗纤溶酶复合物 组织型纤溶酶原激活物-抑制剂复合物 静脉血栓栓塞 

分 类 号：R446.1[医药卫生—诊断学]