摘要
目的:探讨不同血型老年髋部骨折患者术后下肢静脉血栓(VTE)形成的差异性及分子机制.方法:选择我院于2020年1月-2022年12月收治的股骨转子间骨折患者160例,根据血型分组:A型组40例,B型组40例,AB型组40例和O型组40例.所有患者均行闭合复位髓内钉内固定术治疗.比较不同血型组VTE发生情况;比较不同血型组术前和术后1周血栓弹力图(TEG)指标,D-二聚体水平,促凝关键因子和抗凝关键因子水平变化.结果:160例股骨转子间骨折患者,术后VTE发生43例,发生率为26.87％.O型组VTE发生率低于A型组、B型组和AB型组(P＜0.05).不同血型组术前凝血反应时间(R)、凝血形成时间(K)、凝固角(α角)、最大凝块强度(MA)值、D-二聚体、血管性血友病因子(vWF)、VⅢ因子(FVⅢ)、组织因子(TF)、组织因子抑制物(TFPI)、蛋白C(PC)、蛋白S(PS)和血栓调节蛋白(TM)比较无统计学差异(P＞0.05);A型组、B型组和AB型组术后1周R值、TFPI、PC、PS和TM低于术前,而K值、α角、MA值、D-二聚体、vWF、FVⅢ、TF高于术前(P＜0.05);O型组术后1周R值、K值、α角、MA值、D-二聚体、vWF、FVⅢ、TF、TFPI、PC、PS和TM较术前无统计学差异(P＞0.05);O型组术后1周R值、TFPI、PC、PS和TM高于A型组、B型组和AB型组,而K值、α角、MA值、D-二聚体、vWF、FVⅢ、TF低于A型组、B型组和AB型组(P＜0.05).结论:股骨转子间骨折术后VTE形成中O型发生率最低,且O型R值、TFPI、PC、PS和TM较A型组、B型组和AB型组高,而K值、α角、MA值、D-二聚体、vWF、FVⅢ、TF较A型组、B型组和AB型组低,其差异性可能与不同血型患者VTE形成有重要关系.
Abstract
Objective To explore the differences and molecular mechanisms of lower limb venous thrombosis(VTE)formation in elderly patients with hip fractures of different blood types after surgery.Methods 160 patients with intertrochanteric fractures of the femur in our hospital from January 2020 to December 2022 were selected and grouped according to blood type:A-type group of 40 cases,B-type group of 40 cases,AB-type group of 40 cases,and O-type group of 40 cases.All patients underwent closed reduction and intramedullary nail fixation surgery.Compare the incidence of VTE among different blood group groups;compare the changes in thromboelastography(TEG)indicators,D-dimer levels,key coagulation promoting factors,and key anticoagulant factors levels among different blood group groups before and 1 week after surgery.Results Among the 160 patients with intertrochanteric fractures of the femur,43 had postoperative VTF,with an incidence rate of 26.87％.The incidence of VTE in the O-type group was lower than that in the A-type group,B-type group,and AB-type group(P＜0.05).Preoperative R value,K value,α angle,MA value,D-dimer,von willebrand factor(vWF),FV Ⅲ factor(FV Ⅲ),tissue factor(TF),tissue factor pathway inhibitor(TFPI),protein C(PC),protein S(PS),and thrombomodulin(TM)were no significant difference(P＞0.05);the A-type,B-type,and AB-type groups R-values,TFPI,PC,PS,and TM lower before surgery at 1 week,while the K-values,α angle,MA value,D-dimer,vWF,FV Ⅲ,and TF higher before surgery(P＜0.05);the R-value,K-value,α angle,MA value,D-dimer,vWF,FV Ⅲ,TF,TFPI,PC,PS,and TM compared to before surgery no significant differences(P＞0.05);the O-type group R-value,TFPI,PC,PS,and TM higher A-type group,B-type group,and AB type group at 1 week after surgery,while the K-value,α angle,MA value,D-dimer,vWF,FV Ⅲ,and TF lower A-type group,B-type group,and AB-type group(P＜0.05).Conclusion The incidence of postoperative VTE in femoral intertrochanteric fractures is the lowest in type O,and the R-value,TFPI,PC,PS,and TM of O-type group higher A-type,B-type,and AB-type groups,while the K-value,αangle,MA value,D-dimer,vWF,FV Ⅲ,and TF lower A-type,B-type,and AB-type group,and their differences may be closely related to the formation of VTE in patients with different blood types.
基金项目
湖南省自然科学基金(2020JJ4061)
湖南省科技厅,湖南省多发重症创伤救治临床医疗示范基地(2019SK4019)
国家科技期刊平台
NSTL
万方数据