摘要
目的 探究血清中性粒细胞胞外陷阱(NETs)、可溶性CD40配体(sCD40L)水平对下肢骨折患儿术后发生深静脉血栓的预测价值.方法 回顾性选取2022年4月至2023年4月深圳平乐骨伤科医院收治的85例下肢骨折患儿为研究对象,均接受下肢静脉造影检查.根据患儿有无深静脉血栓分组:血栓组(n=22)和正常组(n=63).比较组间术前及术后1 d的血清NETs、sCD40L水平,并对组间临床资料(性别、年龄、体重指数、高血压、糖尿病、受伤类型、受伤至入院时间、术中失血量、手术时间、卧床时间)进行比较;采用多因素Logistics回归分析影响患儿术后发生深静脉血栓的因素;采用受试者操作特征(ROC)曲线评估卧床时间、NETs变化值及sCD40L变化值对患儿术后深静脉血栓发生的预测价值.结果 术后1d,两组的血清NETs、sCD40L水平均较术前升高,且血栓组分别为0.66±0.11、(302.41±42.02)ng/L,均高于正常组[0.51±0.05、(112.20±23.02)ng/L],差异均有统计学意义(P＜0.05);血栓组术前及术后 1 d 的 NETs、sCD40L 水平差值为 0.44±0.05、(196.85±21.02)ng/L,均高于正常组[0.30±0.04、(14.05±3.11)ng/L],差异均有统计学意义(P＜0.05).两组在性别构成比、年龄、体重指数、高血压、糖尿病、受伤类型、受伤至入院时间、术中失血量、手术时间方面比较,差异均无统计学意义(P＞0.05);血栓组的卧床时间长于正常组,差异有统计学意义(P＜0.05).经多因素Logistics回归分析结果可知,卧床时间、NETs变化值及sCD40L变化值均是影响患儿术后发生深静脉血栓发生的因素(P＜0.05).卧床时间、NETs变化值及sCD40L变化值预测患儿术后深静脉血栓的曲线下面积值分别为0.801、0.850、0.825,具有较高预测价值.结论 血清NETs和sCD40L水平在下肢骨折术后发生深静脉血栓患儿中显著升高,其在预测下肢骨折患儿术后深静脉血栓方面具有较高的价值.
Abstract
Objective To explore the predictive value of serum neutrophil extracellular traps(NETs)and soluble CD40 ligand(sCD40L)level on the postoperative occurrence of deep vein thrombosis in children with lower limb fractures.Methods A total of 85 children with lower limb fractures admitted to Shenzhen Pingle Orthopedics Hospital from April 2022 to April 2023 were retrospectively selected as the re-search objects,and all of them underwent lower limb venography.According to the presence or absence of deep vein thrombosis,the patients were divided into the thrombosis group(n=22)and the normal group(n=63).The levels of serum NETs and sCD40L before operation and one day after operation between the two groups were compared,and the clinical data(gender,age,body mass index,hypertension,diabetes,type of inju-ry,time from injury to admission,intraoperative blood loss,operation time,bed rest time)were compared between the two groups.The factors af-fecting postoperative deep venous thrombosis in children were analyzed by multivariate Logistics regression analysis.The predictive value of bed rest time,NETs change value and sCD40L change value for postoperative deep venous thrombosis in children was evaluated using the receiver operating characteristic(ROC)curve.Results One day after operation,the levels of serum NETs and sCD40L in the two groups were higher than those before operation,and the levels of serum NETs and sCD40L in the thrombus group were 0.66±0.11,(302.41±42.02)ng/L,respectively,which were higher than those in the normal group[0.51±0.05,(112.20±23.02)ng/L],the differences were statistically significant(P＜0.05);the differences of NETs and sCD40 L levels in the thrombus group before and 1 d after operation were 0.44±0.05,(196.85±21.02)ng/L,which were higher than those in the normal group[0.30±0.04,(14.05±3.11)ng/L],and the differences were statistically significant(P＜0.05).There were no statistically significant differences in gender composition ratio,age,body mass index,hypertension,diabetes,injury type,time from injury to admission,intraoperative blood loss and operation time between the two groups(P＞0.05),the bedridden time of the thrombus group was longer than that of the normal group,and the difference was statistically significant(P＜0.05).According to the results of multivariate logistic regression analysis,the time of bed rest,the change value of NETs and the change value of sCD40 L were the factors affecting the occurrence of deep venous thrombosis in children after operation(P＜0.05).The area under the curve of bed time,NETs change value and sCD40 L change value for predicting postoperative deep venous thrombosis in children were 0.801,0.850 and 0.825,respectively,with high pre-dictive value.Conclusion Serum NETs and sCD40L levels are significantly increased in children with deep vein thrombosis after lower extremity fracture,and they have high predictive value in predicting postoperative deep vein thrombosis in children with lower extremity fracture.
NETL
NSTL
万方数据