血小板聚集率、ET-1、sEPCR对患者术后下肢深静脉血栓形成的预测效能  

Predictive efficacy of platelet aggregation rate,ET-1,and sEPCR for postoperative deep vein thrombosis of lower extremities in patients

作　　者：魏铁垒 刘景春 杨牧源 王英 张福红 郭俊超 WEI Tie-lei;LIU Jing-chun;YANG Mu-yuan;WANG Ying;ZHANG Fu-hong;GUOJun-chao(Respiratory Department,Xuchang People's Hospital,Xuchang 461000,Henan,CHINA;Respiratory and Critical Care Medicine Department,Xuchang People's Hospital,Xuchang 461000,Henan,CHINA;Department of Orthopedics,Xuchang People's Hospital,Xuchang 461000,Henan,CHINA)

机构地区：[1]许昌市人民医院呼吸科,河南许昌461000 [2]许昌市人民医院呼吸与危重症医学科,河南许昌461000 [3]许昌市人民医院骨科,河南许昌461000

出　　处：《海南医学》2024年第11期1628-1632,共5页Hainan Medical Journal

基　　金：2020年河南省医学科技攻关计划联合共建项目(编号:LHGJ20200772)。

摘　　要：目的探讨血小板聚集率、内皮素-1(ET-1)、可溶性内皮细胞蛋白C受体(sEPCR)对患者术后下肢深静脉血栓(DVT)形成的预测效能。方法回顾性选取2019年6月至2023年3月许昌市人民医院收治的250例骨科手术患者作为研究对象,以术后第7天下肢静脉彩超阳性报告术后并发DVT作为判断依据,将患者分为DVT组77例和非DVT组173例。比较两组患者术前1 d、术后1 d、术后3 d的血小板聚集率、ET-1、sEPCR水平,采用Spearman相关系数分析各指标术后水平与术后发生DVT的相关性,绘制受试者工作特征曲线(ROC)评价各指标联合检测对术后患者发生DVT的预测价值,并分析各指标不同水平患者术后发生DVT的危险度。结果术后1 d、3 d,DVT组患者的血小板聚集率、ET-1、sEPCR水平[(67.41±5.02)%、(73.46±6.23)ng/mL、(159.34±13.91)ng/L,(61.79±4.85)%、(68.17±5.31)ng/mL、(147.39±12.46)ng/L]明显高于非DVT组[(49.25±4.87)%、(55.28±5.36)ng/mL、(115.29±12.28)ng/L,(40.02±4.17)%、(46.15±4.29)ng/mL、(90.36±11.17)ng/L],差异均有统计学意义(P<0.05);经Speraman相关系数分析结果显示,术后1 d、3 d血小板聚集率(r=0.682、0.711)、ET-1(r=0.653、0.691)、sEPCR(r=0.535、0.728)与术后发生DVT均呈正相关(P<0.05);经ROC分析结果显示,术后1 d、3 d,血小板聚集率、ET-1、sEPCR水平联合预测术后发生DVT的AUC分别为0.898(95%CI:0.854~0.933)、0.928(95%CI:0.889~0.957);经危险度分析结果显示,术后1 d、3 d血小板聚集率、ET-1、sEPCR高水平患者术后发生DVT的危险度分别是低水平的2.181倍、2.463倍、3.073倍和3.058倍、3.611倍、4.247倍(P<0.05)。结论血小板聚集率、ET-1、sEPCR水平与术后DVT发生呈正相关,三者联合检测对术后是否发生DVT有预测价值,可作为临床预测骨科术后发生DVT的有效指标。Objective To investigate the predictive efficacy of platelet aggregation rate,endothelin-1(ET-1),and soluble endothelial cell protein C receptor(sEPCR)on postoperative deep vein thrombosis(DVT)of lower extremities.Methods A retrospective study was conducted on 250 patients who underwent orthopedic surgery at Xuchang People's Hospital from June 2019 to March 2023.The patients were divided into a DVT group(77 cases)and a non-DVT group(173 cases)based on the positive report of lower limb vein color Doppler ultrasound on the 7th day after surgery.The platelet aggregation rate,ET-1,and sEPCR levels were compared between the two groups on the 1st day before surgery,the 1st day after surgery,and the 3rd day after surgery.Spearman correlation coefficient analysis was used to evaluate the correlation between the postoperative levels of each indicator and the occurrence of DVT after surgery.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of combined detection of each indicator for the occurrence of DVT in patients after surgery,and the risk of DVT occurrence in patients with different levels of each indicator was analyzed.Results On postoperative day 1 and day 3,the platelet aggregation rate,ET-1,and sEPCR levels in the DVT group[postoperative day 1:(67.41±5.02)%,(73.46±6.23)ng/mL,(159.34±13.91)ng/L;postoperative day 3:(61.79±4.85)%,(68.17±5.31)ng/mL,(147.39±12.46)ng/L]were higher than those in the non-DVT group[postoperative day 1:(49.25±4.87)%,(55.28±5.36)ng/mL,(115.29±12.28)ng/L;postoperative day 3:(40.02±4.17)%,(46.15±4.29)ng/mL,(90.36±11.17)ng/L],and the differences were statistically significant(P<0.05).The results of Speraman correlation coefficient analysis showed that platelet aggregation rate(r=0.682,0.711),ET-1(r=0.653,0.691),and sEPCR(r=0.535,0.728)were positively correlated with the occurrence of DVT after surgery on day 1 and day 3(P<0.05).The ROC analysis results showed that the AUCs of platelet aggregation rate,ET-1,and sEPCR levels for predicting the oc

关 键 词：术后 下肢深静脉血栓 血小板聚集率 内皮素-1 可溶性内皮细胞蛋白C受体 预测效能 

分 类 号：R61[医药卫生—外科学]