摘要
目的 探讨深静脉血栓(DVT)形成患者下肢深静脉血栓密度、血清心肌肌钙蛋白Ⅰ(cTnⅠ)及同型半胱氨酸(Hey)水平与合并肺栓塞风险的关系.方法 回顾性分析2016年1月至2019年1月在秦皇岛市第一医院进行治疗的108例DVT患者,依据是否合并肺栓塞分为对照组(单纯DVT)68例,观察组(DVT合并肺栓塞)40例.收集两组基线资料[年龄、性别、高血压史、高血脂史、慢性肺部疾病、脑血管意外、下肢骨折、吸烟史、饮酒史、血栓受累肢体、受累静脉、下肢深静脉血栓密度比、wells评分、血小板计数(PLT)、中性粒细胞计数(NEUT)、C反应蛋白(CRP)、D二聚体(D-D)、cTnⅠ及Hey水平]并进行比较,分析DVT合并肺栓塞的影响因素.根据肺栓塞危险程度将DVT合并肺栓塞患者划分为高危组(n=10)、中危组(n=17)、低危组(n=13);比较不同危险程度肺栓塞间下肢深静脉血栓密度、血清cTnⅠ、Hey水平及wells评分间差异.分析下肢深静脉血栓密度、血清cTnⅠ及Hey水平与wells评分的关系.结果 两组患者年龄、性别、高血压、高血脂、慢性肺部疾病、脑血管意外、下肢骨折、吸烟史、饮酒史、血栓受累肢体及受累静脉比较,差异均无统计学意义(P＞0.05);观察组下肢深静脉血栓密度比、wells评分、PLT、NEUT、CRP、D-D、cTnⅠ及Hey水平分别为(52.37±12.19)％、(5.16±1.07)分、(284.63±90.72)× 109/L、(71.22±10.16)％、(15.29±2.39)mg/L、(1051.27±271.19)ng/mL、(0.33±0.13)ng/mL、(21.27±2.16)µmol/L,均高于对照组[41.67±10.28)％、(3.28±0.94)分、(206.27±86.15)× 109/L、(64.31±8.75)％、(10.33±1.71)mg/L、(739.52±206.34)ng/mL、(0.21±0.06)ng/mL、(10.19±1.75)µmol/L],差异均有统计学意义(P＜0.05).Logistic回归分析结果显示,下肢深静脉血栓密度比、wells评分、cTnⅠ及Hey为DVT合并肺栓塞的独立预测因子(P＜0.05).肺栓塞低危组下肢深静脉血栓密度比、cT-nⅠ、Hcy水平及wells评分均低于中危组、高危组,差异均有统计学意义(P＜0.05).经Spearman相关性分析,下肢深静脉血栓密度比、cTnⅠ、Hcy水平与wells评分呈正相关(P＜0.05).结论 DVT患者下肢深静脉血栓密度、血清cTnⅠ、Hcy可有效预测合并肺栓塞,同时可判断患者肺栓塞严重程度.
Abstract
Objective To investigate the relationship of lower-extremity deep venous thrombosis density,serum cardiac troponin Ⅰ(cT-nⅠ)and homocysteine(Hey)levels with the risk of pulmonary embolism in patients with deep venous thrombosis(DVT).Methods A total of 108 patients with DVT who were treated in the First Hospital of Qinhuangdao from January 2016 to January 2019 were reviewed.Acccording to whether pulmonary embolism was involved,68 patients with DVT alone and 40 patients with DVT complicated with pulmonary embolism amorg them were defined as the control group and the observation group,respectively.Baseline data[age,gender,history of hypertension,history of hy-perlipidemia,chronic lung disease,cerebrovascular accidents,lower limb fractures,smoking history,drinking history,thrombotic affected limbs,affected veins,lower limb deep vein thrombosis density ratio,wells score,platelet count(PLT),neutrophil count(NEUT),C-reactive protein(CRP),D-dimer(D-D),cTnⅠ and Hey levels]of the two groups were comparatively analyzed.The influencing factors of DVT complicated with pulmonary embolism were analyzed.Patients with DVT combined with pulmonary embolism were divided into high-risk group(n=10),medium-risk group(n=17),and low-risk group(n=13)based on the degree of pulmonary embolism risk.Lower-extremity deep venous thrombosis density,serum cTnⅠ and Hey levels,and Wells scores were compared between patients with different risk levels of pulmonary embol-ism.The relationship of lower-extremity deep venous thrombosis density,serum cTnⅠ and Hey levels with Wells score was analyzed.Results There were no statistically significant differences in the age,gender,hypertension,hyperlipidemia,chronic lung disease,cerebrovascular acci-dents,lower limb fractures,smoking history,drinking history,thrombotic limb and affected veins between the two groups of patients(P＞0.05);the density ratio,wells score,PLT,NEUT,CRP,D-D,cTnⅠ,and Hey levels of lower limb deep vein thrombosis in the observation group were(52.37±12.19)％,(5.16±1.07)points,and(284.63±90.72)× 109/L,(71.22±10.16)％,(15.29±2.39)mg/L,(1 051.27± 271.19)ng/mL,(0.33±0.13)ng/mL,(21.27±2.16)μmol/L,respectively,which were higher than those in the control group[41.67± 10.28)％,(3.28±0.94)points,(206.27±86.15)x 109/L,(64.31±8.75)％,(10.33±1.71)mg/L,(739.52±206.34)ng/mL,(0.21±0.06)ng/mL,(10.19±1.75)µmol/L,the differences were statistically significant(P＜0.05).Logistic regression analysis results showed that lower-extremity deep venous thrombosis density ratio,wells score,cTnⅠ and Hey were independent predictors of DVT complicated with pulmonary embolism(P＜0.05).Lower-extremity deep venous thrombosis density ratio,cTnⅠ and Hey levels,and wells scores in the low-risk pulmonary embolism group were lower than those in the medium-risk group and the high-risk group.Spearman correlation analysis found that lower-extremity deep venous thrombosis density ratio,cTnⅠ and Hey levels were positively correlated with wells score.Conclusion Lower-extremity deep venous thrombosis density,serum cTnl and Hey can help to predict the occurrence of pulmonary embolism and evaluate its severity in patients with DVT.
基金项目
河北省自然科学基金(H2017209143)
秦皇岛市科学技术研究与发展计划(201805A067)
万方数据