人工髋关节置换术后高凝状态患者凝血因子活性变化研究  

Changes of coagulation factor activity in patients with hypercoagulable state after hip arthroplasty

作　　者：刘颖[1] 陈怡蓉 唐笛娇 LIU Ying;CHEN Yirong;TANG Dijiao(Department of Laboratory Medicine,First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院医学检验科,重庆400016

出　　处：《国际检验医学杂志》2022年第24期3032-3036,共5页International Journal of Laboratory Medicine

摘　　要：目的探讨凝血因子活性在人工髋关节置换术后高凝状态中的诊断价值。方法选择2019年1月至2021年5月在重庆医科大学附属第一医院骨科行人工髋关节置换术的133例患者作为研究对象,检测患者术前、术后凝血因子(FⅡ、FⅤ、FⅦ、FⅧ、FⅨ、FⅩ、FⅪ、FⅫ)活性,以及术后血栓弹力图、D-二聚体水平。利用血栓弹力图数据将患者分为术后高凝状态组和术后非高凝状态组。比较两组患者手术前后凝血因子活性变化,分析凝血因子活性与D-二聚体相关性。采用受试者工作特征(ROC)曲线分析各凝血因子联合检测诊断人工髋关节置换术后高凝状态的效能。结果高凝状态组FⅡ、FⅧ、FⅪ和FⅫ手术前后活性差异有统计学意义(P<0.01),非高凝状态组FⅡ、FⅧ、FⅫ手术前后活性差异有统计学意义(P<0.05)。两组患者术前FⅦ和FⅧ活性差异有统计学意义(P<0.05)。ROC曲线分析显示,术前FⅦ、术前FⅧ、术后FⅪ及术前FⅦ+术前FⅧ+术后FⅪ诊断人工髋关节置换术后高凝状态的AUC分别为0.602、0.600、0.514及0.648。结论FⅦ、FⅧ、FⅪ可以作为诊断人工髋关节置换术后高凝状态的新指标,在临床运用中选用术前FⅦ+术前FⅧ+术后FⅪ进行联合检测诊断,可以提高诊断效率,从而尽早预防静脉血栓栓塞症的发生。Objective To investigate the value of coagulation factor activity in the diagnosis of hypercoagulability after hip arthroplasty.Methods A total of 133 patients undergoing hip arthroplasty in the orthopaedic department of this hospital from January 2019 to May 2021 were selected as the study subjects.The activity of coagulation factors(FⅡ,FⅤ,FⅦ,FⅧ,FⅨ,FⅩ,FⅪ,FⅫ),postoperative thrombelastogram and D-dimer level were detected.The patients were divided into the postoperative hypercoagulable state group and postoperative non-hypercoagulable state group by using the thromboelastogram data.The changes of coagulation factor activity before and after operation were compared between the two groups,and the correlation between the coagulation factor activity and D-dimer was analyzed.The receiver operating characteristic(ROC)curve was used to analyze the efficiency of combined diagnosis of various coagulation factors in the hypercoagulable state after hip arthroplasty.Results The activity of FⅡ,FⅧ,FⅪand FⅫin the hypercoagulable state group had statistically significant difference between before and after the operation(P<0.01),the activity of FⅡ,FⅧ,and FⅫin the non-hypercoagulable state group had statistically significantly difference between before and after the operation(P<0.05).There was statistically significant difference in the FⅦand FⅧactivity before operation between the two groups(P<0.05).The ROC curve showed AUC of preoperative FⅦ,preoperative FⅧ,postoperative FⅪ,preoperative FⅦ+preoperative FⅧ+postoperative FⅪfor diagnosing the hypercoagulable state after hip arthroplasty were 0.602,0.600,0.514 and 0.648 respectively.Conclusion FⅦ,FⅧand FⅪcould be used as the new indexes for the diagnosis of hypercoagulable state after artificial hip replacement.Selecting the preoperative FⅦ+preoperative FⅧ+postoperative FⅪcombined diagnosis in clinical application could improve the diagnostic efficiency,thus prevent the occurrence of venous thromboembolism occurrence as early

关 键 词：人工髋关节置换术 凝血因子 D-二聚体 高凝状态 

分 类 号：R446.1[医药卫生—诊断学]