摘要
目的:分析神经重症患者下肢深静脉血栓危险因素及血栓前状态分子标志物的预测价值.方法:回顾性分析2021 年 2 月—2023 年 2 月于德化县医院收治的 80 例患者的病历资料.以术后 3 d是否形成血栓将患者分为血栓组(n=39)和非血栓组(n=41),比较两组病历资料及术前血栓前状态分子标志物水平[组织型纤溶酶原激活剂-纤溶酶原激活剂抑制剂-1 复合物(t-PAIC)、凝血酶-抗凝血酶复合物(TAT)、纤溶酶-2α纤溶酶抑制物复合物(PIC)、血栓调节蛋白(TM)],采用单因素和多因素logistic回归分析神经重症患者下肢深静脉血栓形成的危险因素,通过绘制受试者工作特征(ROC)曲线分析t-PAIC、TAT、PIC、TM对神经重症患者下肢深静脉血栓的预测价值.结果:两组年龄、右下肢肌力、卧床时间、下肢深静脉穿刺、下肢制动、白细胞(WBC)、纤维蛋白原(FIB)、D-二聚体(D-D)、t-PAIC、TAT、PIC、TM、急性生理与慢性健康评分系统(APACHEⅡ)评分、Caprini评分比较,差异有统计学意义(P<0.05);多因素logistic分析结果显示,年龄≥65 岁、下肢制动、D-D升高、t-PAIC、TAT、PIC、TM、Caprini评分是神经重症患者下肢深静脉血栓形成的独立危险因素(P<0.05);ROC曲线显示,TM、TAT、PIC、t-PAIC、联合预测ROC曲线下面积(AUC)分别为 0.672、0.837、0.789、0.633、0.887.结论:血栓前t-PAIC、TAT、PIC、TM水平是影响神经重症患者下肢深静脉血栓的独立危险因素,联合检测能早期识别神经重症患者下肢深静脉血栓高危患者.
Abstract
Objective:To analyze the risk factors of deep vein thrombosis of lower extremities in patients with severe neurological diseases and predictive value of molecular markers of prethrombotic state.Method:The medical records of 80 patients who admitted to Dehua County Hospital from February 2021 to February 2023 were retrospectively analyzed.The patients were divided into the thrombosis group(n=39)and the non-thrombosis group(n=41)according to whether thrombosis occurred 3 d after operation,the medical records and preoperative levels of molecular markers of prethrombotic state[tissue plasminogen activator-plasminogen activator inhibitor-1 complex(t-PAIC),thrombin-antithrombin complex(TAT),plasmin-2α plasmin inhibitor complex(PIC),thrombomodulin(TM)]were compared between two groups,univariate and multivariate logistic regression were used to analyze the risk factors for deep vein thrombosis of lower extremities in patients with severe neurological disease,and the predictive value of t-PAIC,TAT,PIC and TM on deep vein thrombosis of lower extremities in patients with severe neurological disease was analyzed by plotting the receiver working characteristics(ROC)curve.Result:There were significant differences in age,right lower limb muscle strength,bed rest time,lower limb deep vein puncture,lower limb braking,white blood cell(WBC),fibrinogen(FIB),D-dimer(D-D),t-PAIC,TAT,PIC,TM,acute physiology and chronic health scores system(APACHEⅡ)score and Caprini score between two groups(P<0.05).Multivariate logistic analysis showed that age≥65 years old,lower extremity immobilization,D-D elevation,t-PAIC,TAT,PIC,TM,Caprini scores were independent risk factors for of deep vein thrombosis of lower extremities in patients with severe neurological disease(P<0.05);ROC curve showed that the area under ROC curve(AUC)of TM,TAT,PIC,t-PAIC and combined prediction were 0.672,0.837,0.789,0.633 and 0.887,respectively.Conclusion:The levels of t-PAIC,TAT,PIC and TM before thrombosis are independent risk factors for deep vein thrombosis of low extremities in patients with severe neurological diseases,combined detection can early identify high-risk patients with deep vein thrombosis of lower extremities in patients with severe neurological diseases.
国家科技期刊平台
NSTL
维普
万方数据