凝血相关指标在评估危重症患者静脉血栓栓塞风险中的应用  

Use of coagulation-related markers in assessing the risk of venous thromboembolism in critically ill patients

作　　者：代炼 陈莉 封彦楠 肖永琴 DAI Lian;CHEN Li;FENG Yannan;XIAO Yongqin(Blood Transfusion Department,Sichuan Cancer Hospital,Cancer Hospital Affiliated to University of Electronic Science and Technology Medical College,Chengdu 610041,China)

机构地区：[1]四川省肿瘤医院·电子科技大学医学院附属肿瘤医院输血科,四川成都610041

出　　处：《西部医学》2024年第6期866-870,共5页Medical Journal of West China

基　　金：四川省卫生健康科研基金项目(20210396)。

摘　　要：目的探讨血栓调节素(TM)、凝血酶-抗凝血酶复合物(TAT)、α2-纤溶酶抑制剂-纤溶酶复合物(PIC)和组织纤溶酶原激活物-抑制剂复合物(t-PAIC)在评估危重症患者静脉血栓栓塞(VTE)风险和预后中的价值。方法纳入2020年10月—2022年11月本院ICU收治的254例危重症患者资料行回顾性分析。根据有无VTE分为VTE组(106例)和无VTE组(148)。使用高灵敏度化学发光酶免疫测定法测量患者空腹静脉血中TAT、PIC、TM和t-PAIC水平。使用二元逻辑回归分析TAT、PIC、TM、t-PAIC和VTE之间的关系。采用受试者工作特征(ROC)曲线评价它们在区分VTE中的诊断效率。使用Kaplan-Meier方法估计患者的28 d存活率。结果在纳入患者中,VTE发生率41.7%,包括16.5%肺血栓栓塞(PE),20.5%深静脉血栓(DVT)和4.7%其他(静脉导管或浅静脉)血栓形成。与无VTE组相比,VTE组入院时血管加压药使用比例、机械通气比例、CRP水平、TAT、PIC、TM、t-PAIC、D-二聚体、纤维蛋白降解产物水平显著升高(均P<0.05)。多变量分析显示TAT、PIC、TM、t-PAIC与危重症患者VTE密切相关(P<0.05)。在4个凝血标志物中,tPAIC的最低曲线下面积(AUC)为0.615,TAT的最高AUC为0.711。当应用TAT、PIC、TM、t-PAIC的组合时,AUC增加到0.814,敏感性增加到74.1%。在4种凝血标志物中,TAT、PIC和TM高水平患者的28 d存活率显著低于低水平患者(P<0.05)。结论TAT、PIC、TM、t-PAIC联合在评估危重症患者VTE中表现出良好的诊断性能,并优于单一标志物。Objective To investigate thrombomodulin(TM),thrombin-antithrombin complex(TAT),α2-plasmin inhibitor-plasmin complex(PIC)and tissue plasminogen activator-inhibitor complex(t-PAIC)in assessing the risk and prognosis of venous thromboembolism(VTE)in critically ill patients.Methods This study retrospectively analyzed the data of 254 critically ill patients admitted to the ICU of our hospital from October 2020 to November 2022.Fasting venous blood levels of TAT,PIC,TM and t-PAIC were measured using a highly sensitive chemiluminescent enzyme immunoassay.The relationship between TAT,PIC,TM,t-PAIC and VTE was analyzed using binary logistic regression.Receiver operating characteristic(ROC)curves were used to evaluate their diagnostic efficiency in differentiating VTE.The 28-day survival of patients was estimated using the Kaplan-Meier method.Results Among the 254 patients,106(41.7%)developed VTE,including 16.5%with pulmonary thromboembolism,20.5%with deep vein thrombosis,and 4.7%with other(catheter or superficial vein)thrombosis.Compared with the non-VTE group,the levels of TAT,PIC,TM,t-PAIC,D-dimer,and fibrin degradation product in the VTE group were significantly increased(all P<0.05).Multivariate analysis showed that TAT,PIC,TM,and t-PAIC were closely related to VTE in critically ill patients(P<0.05).Among the four coagulation markers,the lowest area under the curve(AUC)of tPAIC was 0.615 and the highest AUC of TAT was 0.711.When the combination of TAT,PIC,TM,t-PAIC was applied,the AUC increased to 0.814 and the sensitivity increased to 74.1%.Among the four coagulation markers,the 28-day survival rate of patients with high levels of TAT,PIC and TM was significantly lower than that of patients with low levels(P<0.05).Conclusion The combination of TAT,PIC,TM and t-PAIC is superior to the application of single marker in the diagnosis of VTE in critically ill patients.

关 键 词：血栓调节素 凝血酶-抗凝血酶复合物 α2-纤溶酶抑制剂-纤溶酶复合物 组织纤溶酶原激活物-抑制剂复合物 危重症 静脉血栓栓塞 

分 类 号：R543[医药卫生—心血管疾病]