狼疮抗凝物比值、D-二聚体、可溶性内皮细胞蛋白C受体对早期深静脉血栓形成的诊断价值分析  

The diagnostic value of lupus anticoagulant ratio,D-dimer and soluble endothelial protein C receptor for early deep vein thrombosis

作　　者：李建兰 林涛 李仲飞 陈佳琴 Li Jianlan;Lin Tao;Li Zhongfei;Chen Jiaqin(Department of Clinical Laboratory,Zhejiang Rongjun Hospital,Zhejiang Jiaxing 314000,China)

机构地区：[1]浙江省荣军医院检验科,浙江嘉兴314000

出　　处：《中国医师进修杂志》2020年第12期1120-1124,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的:探究狼疮抗凝物(LA)比值、D-二聚体(D-D)、可溶性内皮细胞蛋白C受体(sEPCR)对深静脉血栓形成(DVT)的早期预测价值。方法:以浙江省荣军医院2018年10月至2019年10月收治的下肢骨折手术患者350例为研究对象,以下肢深静脉造影为金标准,确诊DVT患者82例为观察组,非DVT患者268例为对照组,比较两组LA比值、D-D及sEPCR水平的差异;采用Pearson相关分析血浆sEPCR水平与LA比值、D-D水平的相关性,采用受试者工作特征(ROC)曲线评估血浆sEPCR、LA比值、D-D水平对DVT的预测价值。结果:观察组血浆sEPCR水平、LA比值、D-D水平均高于对照组[(143.30±11.28)μg/L比(112.56±14.62)μg/L、1.51±0.24比1.22±0.18、(1013.00±319.54)μg/L比(425.17±100.36)μg/L],差异有统计学意义(P<0.05)。两组活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)比较差异无统计学意义(P>0.05)。观察组患者血浆sEPCR水平与LA比值、D-D水平均呈正相关(r=0.280,P=0.011;r=0.563,P<0.001),LA比值与D-D水平也呈正相关(r=0.741,P<0.001)。D-D诊断DVT的曲线下面积(AUC)为0.940,截断值569.43μg/L时诊断DVT的灵敏度、特异度为87.80%、87.69%;LA比值诊断DVT AUC最小,为0.912,截断值1.23时灵敏度、特异度为87.80%、91.25%;sEPCR+LA比值+DD诊断DVT灵敏度为95.12%,特异度为95.00%。结论:LA比值、D-D联合sEPCR对DVT有较高的预测价值。Objective To investigate the early predictive value of lupus anticoagulant(LA)ratio,D-dimer(D-D)and soluble endothelial protein C receptor(sEPCR)on deep vein thrombosis(DVT).Methods Thirty hundred and fifty patients who performed surgery for lower extremity fracture and suspected DVT in Zhejiang Rongjun Hospital from October 2018 to October 2019 were enrolled.With deep vein contrast of the lower extremity as the gold standard,82 patients with confirmed DVT were treated as the observation group and 268 patients without DVT as the control group.The levels of LA,D-D and sEPCR of two groups were detected by coagulation,immunoturbidimetry and enzyme linked immunosorbent assay—sandwich technique respectively.Indexes of the two groups were compared.Pearson correlation was used to analyze the relationship between plasma levels of LA,D-D and sEPCR,and the predictive value of plasma sEPCR,LA ratio and D-D level on DVT was evaluated by receiver operator characteristic(ROC)curve.Results The plasma sEPCR,LA ratio and D-D levels in the observation group were significantly higher than those in the control group[(143.30±11.28)μg/L vs.(112.56±14.62)μg/L,1.51±0.24 vs.1.22±0.18,(1013.00±319.54)μg/L vs.(425.17±100.36)μg/L]with statistically significant differences(P<0.05).There was no significant differences in activated partial thromboplastin time(APTT),prothrombin time(PT)and thrombin time(TT)between the two groups(P>0.05).In the observation group,plasma sEPCR level was positively correlated with LA ratio and D-D level(r=0.280,P=0.011;r=0.563,P<0.001),and LA ratio was positively correlated with D-D level(r=0.741,P<0.001).The area under curve(AUC)of D-D in diagnosis of DVT was 0.940,and the sensitivity and specificity were 87.80%and 87.69%when the cut-off value was 569.43μg/L.The AUC of LA ratio in the diagnosis of DVT was the smallest,which was 0.912,the sensitivity and specificity were 87.80%and 91.25%when the cut-off value was 1.23.The sensitivity was 95.12%and specificity was 95.00%of sEPCR and LA ratio combined wi

关 键 词：血栓形成 狼疮凝固抑制物 D-二聚体 可溶性内皮细胞蛋白C受体 

分 类 号：R766[医药卫生—耳鼻咽喉科]