外周血miR-483-3p联合血栓弹力图对老年下肢骨折合并冠心病患者发生深静脉血栓的风险评估作用  

Peripheral blood miR-483-3p detection combined with thromboelastography in predicting the risk of deep vein thrombosis in elderly patients with lower limb fracture and coronary heart disease

作　　者：付敏[1] 王雅坤[1] 田斌[1] 李猛[2] 张金盈[3] FU Min;WANG Yakun;TIAN Bin;LI Meng;ZHANG Jinying(Department of Cardiology,the Fourth Hospital of Buotou,Baotou 014030,China;Departinent of Cardiology,Baotou Central Hospital,Baotou 014040,China;Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]包头市第四医院心内科,内蒙包头014030 [2]包头市中心医院心内科,内蒙古包头014040 [3]郑州大学第一附属医院心内科,郑州450052

出　　处：《中华实用诊断与治疗杂志》2020年第12期1223-1227,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：包头市医药卫生科技计划项目(wsjj2019063);国家自然科学基金(81570274)。

摘　　要：目的观察老年下肢骨折合并冠心病患者行骨折内固定术后深静脉血栓(deep vein thrombosis,DVT)发生情况,探讨外周血miR-483-3p联合血栓弹力图监测对老年下肢骨折合并冠心病患者术后发生DVT风险评估的价值。方法120例老年下肢骨折合并冠心病患者,根据术后是否发生DVT将其分为DVT组49例和无DVT组71例。骨折内固定术术后次日采用实时荧光定量PCR法检测患者外周血miR-483-3p相对表达量,并进行血栓弹力图监测;比较2组一般资料、外周血miR-483-3p相对表达量和血栓弹力图结果;采用多因素logistic回归分析老年下肢骨折合并冠心病患者骨折内固定术后发生DVT的影响因素;绘制ROC曲线,评估外周血miR-483-3p、血栓弹力图监测预测老年下肢骨折合并冠心病患者骨折内固定术后发生DVT的价值。结果DVT组有高血压史比率(36.73%)、术后下床时间>5 d比率(59.18%)、术后外周血miR-483-3p相对表达量(3.58±0.61)高于无DVT组(18.31%、32.39%、0.77±0.08)(P<0.05),术后血栓弹力图的R值[(4.13±0.62)min]、K值[(1.02±0.35)min]小于无DVT组[(8.53±0.94)、(1.54±0.36)min],α角[(71.30±8.02)°]、MA值[(65.52±7.06)mm]大于无DVT组[(64.82±7.96)°、(58.87±6.24)mm](P<0.05)。有高血压史(OR=6.303,95%CI:4.251~8.463,P=0.008)、术后下床时间>5 d(OR=7.799,95%CI:5.014~9.862,P=0.008)、外周血miR-483-3p相对表达量(OR=4.289,95%CI:2.598~5.987,P<0.001)、R值(OR=2.542,95%CI:1.971~3.204,P<0.001)、K值(OR=3.865,95%CI:2.054~5.568,P<0.001)、α角(OR=3.511,95%CI:1.986~5.093,P=0.005)、MA值(OR=2.787,95%CI:1.964~3.561,P=0.002)是老年下肢骨折合并冠心病患者术后发生DVT的影响因素。当外周血miR-483-3p相对表达量、R值、K值、α角、MA值最佳截断值分别为3.24、4.08 min、1.15 min、70.26°、64.23 mm时,预测老年下肢骨折合并冠心病患者术后发生DVT的AUC分别为0.721(95%CI:0.547~0.933,P=0.011)、0.794(95%CI:0.702~0.885,P=0.004)、0.802(95%CI:0.756~0.862,P=0.002)、Objective To observe the occurrence of deep vein thrombosis(DVT)in elderly patients with coronary heart disease undergoing internal fixation for lower limb fractures,and to explore the value of peripheral blood miR-483-3 p detection combined with thromboelastography monitoring to the risk assessment of postoperative DVT.Methods Totally 120 elderly patients with lower limb fractures and coronary heart disease were divided into DVT group(n=49)and no-DVT group(n=71).Real-time fluorescence quantitative PCR method was used to detect the relative expression of miR-483-3 p in peripheral blood and the thromboelastography was done on the next day after internal fracture fixation.The general data,the relative expression of peripheral blood miR-483-3 p and the results of thromboelastography were compared between two groups.Multivariate logistic regression was used to analyze the risk factors of DVT after surgery in elderly patients with lower limb fractures and coronary heart disease.ROC was drawn to assess the values of peripheral blood miR-483-3 p and thromboelastography monitoring to the prediction of DVT.Results The prevalence of hypertension(36.73%),the percentage of patients with postoperative off-bed activity time>5 days(59.18%),and the relative expression of miR-483-3 p in peripheral blood(3.58±0.61)in DVT group were higher than those in no-DVT group(18.31%,32.39%,0.77±0.08)(P<0.05).The R value(4.13±0.62)and K value(1.02±0.35)on postoperative thromboelastogram in DVT group were lower than those in no-DVT group(8.53±0.94,1.54±0.36),while theαangle((71.30±8.02)°)and MA value((65.52±7.06)mm)in DVT group were greater than those in no-DVT group((64.82±7.96)°,(58.87±6.24)mm)(P<0.05).The history of hypertension(OR=6.303,95%CI:4.251-8.463,P=0.008),postoperative off-bed activity time>5 days(OR=7.799,95%CI:5.014-9.862,P=0.008),peripheral blood miR-483-3 p(OR=4.289,95%CI:2.598-5.987,P<0.001),R value(OR=2.542,95%CI:1.971-3.204,P<0.001),K value(OR=3.865,95%CI:2.054-5.568,P<0.001),αangle(OR=3.511,95%CI:1.986-5.093,P

关 键 词：骨折 冠心病 老年 深静脉血栓 微小RNA-483-3p 血栓弹力图 

分 类 号：R541.4[医药卫生—心血管疾病] R683.42[医药卫生—内科学]