血栓分子标志物在下肢深静脉血栓患者中的诊断价值及抗凝疗效  

The diagnostic value and anticoagulant effect of thrombus molecular markers in patients with deep vein thrombosis of lower extremities

作　　者：孙国栋[1] 王秀霞[1] 苏艳红 谷洪婷 马波民 SUN Guodong;WANG Xiuxia;SU Yanhong;GU Hongting;MA Bomin(Heze Municipal Hospital,Heze 274000,Shandong)

机构地区：[1]菏泽市立医院,山东菏泽274000

出　　处：《菏泽医学专科学校学报》2023年第2期9-13,共5页Journal of Heze Medical College

摘　　要：目的研究血栓分子标志物在下肢深静脉血栓(DVT)患者中的临床应用价值。方法收集该院确诊为下肢DVT的患者54例为血栓组,健康人群106例为对照组。对所有纳入人群入院时检测血栓分子标志物[血浆凝血酶-抗凝血酶Ⅲ复合物(TAT)、纤溶酶-α2纤溶酶抑制物复合物(PIC)、血栓调节蛋白(TM)、组织纤溶酶原激活物/纤溶酶原激活物抑制剂-1复合物(t-PAIC)、D-二聚体(D-D)、纤维蛋白(原)降解产物(FDP)]水平以及常规凝血指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、PT活动度(PT%)、国际标准化比值(INR)、凝血酶时间(TT)]。对有下肢深静脉血栓患者进行低分子肝素抗凝治疗,并于治疗后第1、3、7天检测血栓分子标志物和常规凝血指标水平。结果血栓组患者血浆中TAT、PIC、D-D、FDP水平明显高于对照组(P<0.05),但两组TM、t-PAIC水平比较,P>0.05。受试者工作特征(ROC)曲线分析发现,血浆中TAT、PIC、TM、t-PAIC、D-D、FDP水平诊断DVT的ROC曲线下面积(AUC)分别为0.720、0.810、0.579、0.596、0.938和0.943,六项指标合并之后的ROC曲线下面积0.938;常规凝血指标PT、APTT、TT、INR、PT%的AUC分别为0.698、0.511、0.393、0.715和0.40。血栓组患者抗凝治疗后血浆中TAT、FDP水平明显低于抗凝治疗前(P<0.05);而血浆中PIC、TM、t-PAIC和D-D水平在抗凝治疗前后差异无统计学意义(P>0.05)。结论血栓分子标志物TAT、PIC、TM、t-PAIC、D-D、FDP在诊断DVT领域明显优于常规凝血指标APTT、PT、PT%、INR、TT,可以作为DVT诊断的一种有效手段,同时也可用于临床抗凝治疗疗效监测以及预后评估。Objective To explore the clinical application value of thrombus molecular markers in patients with deep vein thrombosis(DVT)of lower extremities.Methods 54 patients diagnosed with lower extremities DVT were selected as the thrombus group,and at the same time 106 healthy individuals were selected as the control group.The levels of thrombus molecular markers(TAT,PIC,TM,t-PAIC,D-D and FDP)and conventional coagulation indicators(APTT,PT,PT%,INR and TT)were detected in all objects of study.On the first,third and seventh days after treatment,the levels of thrombus molecular markers and conventional coagulation indexes were measured in the thrombus group.Results The levels of TAT,PIC,D-D,and FDP in the thrombus group were significantly higher than those in the control group(P<0.05),and there was no statistically significant difference in the levels of TM and t-PAIC between the two groups.Receiver operating characteristic(ROC)curve analysis found that the area under the ROC curve(AUC)of TAT,PIC,TM,t-PAIC,FDP,and D-D levels in plasma for the diagnosis of DVT were 0.720,0.810,0.810,0.579,0.596,0.938 and 0.943 respectively;the AUC after the combination of six indicators is 0.938.The AUC of routine coagulation indicators PT,APTT,TT,INR and PT%were 0.698,0.511,0.393,0.715 and 0.40 respectively.After anticoagulation treatment,the levels of TAT and FDP were significantly lower than those before anticoagulation treatment in the thrombosis group(P<0.05).There was no significant difference in the levels of PIC,TM,t-PAIC and D-D before and after anticoagulation treatment in the thrombosis group(P>0.05).Conclusion Thrombus molecular markers TAT,PIC,TM,t-PAIC,D-D and FDP are significantly better than the conventional coagulation indicators APT,PT,PT%,INR,TT in the diagnosis of DVT,which can be used as the diagnostic method of lower extremities DVT,and can be used as efficacy monitoring and prognosis evaluation for clinical anticoagulant therapy.

关 键 词：血栓分子标志物 深静脉 诊断 抗凝 

分 类 号：R364.15[医药卫生—病理学]