血栓分子标志物在创伤性下肢骨折深静脉血栓诊断价值的研究  

Research on the diagnostic value of thrombus molecular markers in deep vein thrombosis of traumatic lower limb fracture

作　　者：黄渊凤 陈曦[2] 杨丽琼[2] 鄂建飞[2] HUANG Yuanfeng;CHEN Xi;YANG Liqiong;E Jianfei(The People’s Hospital of Jianyang City,Sichuan,Jianyang 641400,China;Deyang People’s Hospital,Sichuan,Deyang 618000,China)

机构地区：[1]四川省简阳市人民医院,四川简阳641400 [2]四川省德阳市人民医院,四川德阳618000

出　　处：《中国医药科学》2025年第5期80-83,93,共5页China Medicine And Pharmacy

基　　金：四川省医学(青年创新)科研课题(S21029);成都中医药大学“杏林学者”学科人才科研提升计划(YYZX2022072)。

摘　　要：目的探讨创伤性下肢骨折患者发生深静脉血栓(DVT)的危险因素,同时评估组织型纤溶酶原激活剂-纤溶酶原激活剂抑制物复合物(tPAIC)、纤溶酶-ɑ2-抗纤溶酶复合物(PIC)、可溶性血栓调节蛋白(sTM)、凝血酶-抗凝血酶复合物(TAT)对创伤性下肢骨折DVT的诊断价值。方法收集2022年10月至2023年9月德阳市人民医院住院的下肢骨折患者252例,根据术后下肢静脉的彩色多普勒超声检测结果,分为非DVT组(191例)和DVT组(61例),比较两组患者血栓分子标志物水平,采用多因素logistic回归分析创伤性下肢骨折患者发生DVT的危险因素,并采用受试者工作特征曲线(ROC)对各指标的诊断效能进行评价。结果DVT组不同骨折部位比率进行比较,髋部骨折、股骨骨折和胫骨骨折比率分别为44.26%、32.79%、16.39%,差异有统计学意义(P<0.001)。多因素logistic回归分析结果显示髋部骨折、Caprini评分、tPAIC、PIC、sTM、TAT和D-二聚体(D-D)是创伤性下肢骨折发生DVT的危险因素(P<0.05)。PIC、TAT、D-D的曲线下面积(AUC)分别为0.814、0.752、0.886,tPAIC+PIC+sTM+TAT+D-D+Caprini评分联合诊断DVT的AUC为0.951。结论围手术期髋部骨折患者DVT的发生率较高。血栓分子标志物联合Caprini评分,对创伤性下肢骨折DVT诊断价值较高,值得临床推广应用。Objective To investigate the risk factors of deep vein thrombosis(DVT)in patients with traumatic lower limb fracture,and to simultaneously evaluate the diagnostic value in DVT with traumatic lower limb fracture by tissue plasminogen activator-plasminogen activator inhibitor complex(tPAIC),plasmin-α2-plamin inhibitor complex(PIC),soluble thrombomodulin(sTM)and thrombin-antithrombin complex(TAT).Methods A total of 252 patients with lower limb fracture in Deyang People’s Hospital from October 2022 to September 2023 were collected and divided into the non-DVT group(n=191)and the DVT group(n=61)according to the results of color Doppler ultrasound detection of lower limb veins after operation.The levels of thrombus molecular markers in patients of the two groups were compared,and the risk factors of DVT in patients with traumatic lower limb fracture were analyzed by multivariate logistic regression,and the indicators were diagnosed by receiver operating characteristic(ROC).Results The ratios of different fracture sites in the DVT group were compared,with hip fracture,femur fracture,and tibia fracture ratios of 44.26%,32.79%,and 16.39%,respectively,with statistically significant differences(P<0.001).The results of multiple logistic regression analysis showed that hip fracture,Caprini score,tPAIC,PIC,sTM,TAT,and D-dimer(D-D)were risk factors for DVT in traumatic lower limb fracture(P<0.05).The area under the curve(AUC)of PIC,TAT,and D-D were 0.814,0.752,and 0.886,respectively.The AUC of tPAIC+PIC+sTM+TAT+D-D+Caprini score combined diagnosis of DVT was 0.951.Conclusion The incidence of DVT in patients with hip fracture during perioperative period is high.The combination of thrombus molecular markers and Caprini score has relatively high diagnostic value for DVT in patients with traumatic lower limb fracture,which is worthy of clinical prom otion and application.

关 键 词：创伤性骨折 深静脉血栓 危险因素 生物标志物 诊断价值 

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