糖尿病肾病患者血栓相关因子动态评估对血栓风险的预测价值  

Predictive value of dynamic assessment of thrombose-related factors in diabetic nephropathy patients for thrombotic risk

作　　者：刘晓 白海龙 边云[1] LIU Xiao;BAI Hailong;BIAN Yun(Diabetes Department,Cangzhou Hospital of Intergrated TCM-WM·Hebei,Cangzhou,Hebei 061001,China)

机构地区：[1]河北省沧州中西医结合医院糖尿病科,河北沧州061001

出　　处：《中国临床研究》2024年第7期1055-1059,共5页Chinese Journal of Clinical Research

基　　金：河北省中医药管理局科研计划项目(2023259)。

摘　　要：目的探讨血栓相关因子动态评估对糖尿病肾病(DN)患者血栓风险的预测价值。方法回顾性选取2020年1月至2022年9月于沧州中西医结合医院进行治疗的98例DN患者为研究对象,治疗后进行随访,以患者出现深静脉血栓为观察终点,最终96例获得随访,根据有无血栓形成分为血栓组(n=21)和非血栓组(n=75)。收集患者的临床资料,通过单因素和多因素logistic分析DN患者血栓风险的影响因素。采用受试者工作特征(ROC)曲线评价血栓相关因子[凝血酶—抗凝血酶复合物(TAT)、纤溶酶-α-2-纤溶酶抑制剂复合物(PIC)、组织型纤溶酶原激活物/纤溶酶原激活物抑制剂-1复合物(t-PAIC)和可溶性血栓调节蛋白(sTM)]对DN患者血栓风险的预测价值。结果两组患者一般资料、糖尿病病程、糖代谢、脂代谢和肾功能指标比较差异无统计学意义(P>0.05);两组患者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及D-二聚体(D-D)比较,差异有统计学意义(P<0.05);血栓组患者TAT、PIC、t-PAIC、sTM治疗前和后的水平,治疗前后水平的差值,治疗前后的变异系数,均高于非血栓组患者(P<0.01)。多因素logistic回归分析结果显示,TAT、PIC、t-PAIC、sTM的变异系数增高(OR=3.367,P=0.010;OR=19.106,P=0.042;OR=4.313,P=0.005;OR=9.389,P=0.003)为影响DN患者血栓风险的独立危险因素。ROC曲线结果显示,TAT、PIC、t-PAIC和sTM的变异系数预测DN患者血栓风险的AUC分别为0.818、0.806、0.873和0.825。结论血栓相关因子水平增高是DN患者血栓风险的独立危险因素,TAT、sTM、PIC和t-PAIC可作为预测其血栓风险的重要指标。Objective To explore the value of dynamic evaluation of thromose-related factors for predicting thrombotic risk in diabetic nephropathy(DN)patients.Methods A retrospective study was conducted to select 98 patients with DN who were treated in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to September 2022.Follow-up was conducted after treatment,with the occurrence of deep vein thrombosis as the observation endpoint.Finally,96 patients obtained follow-up and were divided into the thrombosis group(n=21)and the non-thrombosis group(n=75)based on the presence or absence of thrombosis.The clinical data of patients were collected,and the influencing factors of thrombotic risk of DN patients were analyzed by univariate and multivariate logistic analysis.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of thrombose-related factors[thrombin-antithrombin complex(TAT),plasmin-α-2-plasmin inhibitor complex(PIC),tissue plasminogen activator/plasminogen activator inhibitor-1 complex(t-PAIC)and soluble thrombomodulin(sTM)]for thrombotic risk in DN patients.Results There was no significant difference in general information,duration of diabetes,glucose metabolism,lipid metabolism and renal function between the two groups(P>0.05).The differences in prothrombin time(PT),activated partial thromboplastin time(APTT)and D-dimer(D-D)between the two groups were statistically significant(P<0.05).In the thrombosis group,the levels of TAT,PIC,t-PAIC and sTM before and after treatment,the difference between pro-treatment and post-treatment,and the variation coefficient between pro-treatment and post-treatment were all increased compared to the non-thrombosis group(P<0.01).Multivariate logistic regression analysis showed that the increased variation coefficients of TAT,PIC,t-PAIC and sTM(OR=3.367,P=0.010;OR=19.106,P=0.042;OR=4.313,P=0.005;OR=9.389,P=0.003)were the independent risk factors affecting the thrombotic risk in DN patients.The ROC curve results sho

关 键 词：糖尿病肾病 血栓 凝血酶—抗凝血酶复合物 纤溶酶-α-2-纤溶酶抑制剂复合物 组织型纤溶酶原激活物/纤溶酶原激活物抑制剂-1复合物 可溶性血栓调节蛋白 

分 类 号：R587.2[医药卫生—内分泌]