术前血清趋化因子配体3和P-选择素水平预测骨盆骨折术后下肢深静脉血栓形成的应用价值  

The application value of presurgical serum chemokine(C-C motif)ligand 3 and P-selectin levels in predicting lower limb deep venous thrombosis following the pelvic fracture surgery

作　　者：刘中怀 李嘉平 王伟 李云伟 李萧 姜磐 LIU Zhonghuai;LI Jiaping;WANG Wei;LI Yunwei;LI Xiao;JIANG Pan(The Fourth People’s Hospital of Langfang,Langfang 065700,Hebei,China)

机构地区：[1]廊坊市第四人民医院,河北廊坊065700

出　　处：《中医正骨》2024年第11期10-14,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：2023年廊坊市科学技术研究与发展计划自筹经费项目(2023013007)。

摘　　要：目的:探讨术前血清趋化因子配体3和P-选择素水平预测骨盆骨折术后下肢深静脉血栓形成(deep venous thrombosis,DVT)的应用价值。方法:纳入拟采用手术治疗的骨盆骨折患者,从病历系统中提取年龄、性别、体质量指数、是否合并高血压、是否合并糖尿病等信息。于手术前1 d采集患者静脉血,检测血清总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、C反应蛋白、血红蛋白、趋化因子配体3及P-选择素水平,以及血浆纤维蛋白原水平、D-二聚体水平、活化部分凝血活酶时间、凝血酶原时间、凝血酶时间。于手术后1 d、7 d、14 d分别检测患者下肢DVT的发生情况。根据患者术后是否发生下肢深静脉血栓将纳入的患者分为下肢DVT组和无下肢DVT组。先对2组患者的相关信息进行单因素分析,然后对其中组间差异有统计学意义的因素进行多因素Logistic回归分析。采用受试者操作特征(receiver operating characteristic,ROC)曲线评价影响因素预测骨盆骨折术后下肢DVT的应用价值。结果:共纳入196例骨盆骨折患者,下肢DVT组38例,无下肢DVT组158例。单因素分析结果显示,2组患者术前血清高密度脂蛋白胆固醇、C反应蛋白、血红蛋白、趋化因子配体3、P-选择素水平,以及血浆纤维蛋白原、D-二聚体水平比较,组间差异均有统计学意义[(1.04±0.22)mmol·L^(-1),(1.21±0.35)mmol·L^(-1),t=2.858,P=0.005;(36.18±3.72)mg·L^(-1),(23.48±2.69)mg·L^(-1),t=24.116,P=0.000;(98.43±9.65)g·L^(-1),(91.28±9.21)g·L^(-1),t=4.257,P=0.000;(15.65±2.13)pg·mL^(-1),(12.57±1.76)pg·mL^(-1),t=9.283,P=0.000;(45.43±5.11)ng·mL^(-1),(38.57±4.06)ng·mL^(-1),t=8.871,P=0.000;(4.57±0.53)g·L^(-1),(3.72±0.41)g·L^(-1),t=10.804,P=0.000;(978.64±98.73)μg·L^(-1),(467.45±48.26)μg·L^(-1),t=46.239,P=0.000]。Logistic回归分析结果显示,术前血清趋化因子配体3和P-选择素水平是术后下肢DVT的危险因素(β=0.921,Objective:To explore the applied value of presurgical serum levels of chemokine(C-C motif)ligand 3(CCL3)and P-selectin in predicting lower limb deep venous thrombosis(LDVT)following the pelvic fracture surgery.Methods:The patients with pelvic fractures scheduled for being treated by surgery were selected and enrolled in the study,and the information including age,gender,body mass index,whether combined with hypertension,and whether combined with diabetes was extracted from the Electronic Medical Record System(EMRS).On presurgical day 1,the blood was drawn from the vein,and the serum levels of total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),C-reactive protein(CRP),hemoglobin(Hb),CCL3 and P-selectin,the plasma levels of fibrinogen(FIB)and D-dimer,the activated partial thromboplastin time(APTT),prothrombin time(PT)and thrombin time(TT)were detected.On postsurgical day 1,7 and 14,the incidence of LDVT was assessed,respectively.The patients were divided into LDVT group and non-LDVT group according to whether LDVT was found after the surgery.The single-factor analysis was conducted on the extracted information of patients in the 2 groups,followed by multi-factor logistic regression analysis on the factors with statistically significant differences between the 2 groups.Furthermore,the applied values of influencing factors in predicting LDVT following the pelvic fracture surgery were analyzed and evaluated by using receiver operating characteristic(ROC)curve.Results:One hundred and ninety-six patients with pelvic fracture were included in the final analysis,38 cases in LDVT group and 158 cases in non-LDVT group.The single-factor analysis showed that the differences were statistically significant between LDVT group and non-LDVT group in the serum levels of HDL-C,CRP,Hb,CCL3 and P-selectin,as well as the plasma levels of FIB and D-dimer(1.04±0.22 vs 1.21±0.35 mmol/L,t=2.858,P=0.005;36.18±3.72 vs 23.48±2.69 mg/L,t=24.116,P=0.000;98.43±9.65 vs

关 键 词：骨盆 骨折 静脉血栓形成 趋化因子类 配体 P-选择素 危险因素 Logistic模型 ROC曲线 

分 类 号：R687.3[医药卫生—骨科学] R543.6[医药卫生—外科学]