创伤性骨折患者高密度脂蛋白水平与深静脉血栓相关性的研究
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摘要
目的探讨创伤性骨折患者血清高密度脂蛋白(HDL-C)水平与深静脉血栓形成的相关性。方法对2012年4月至2014年12月1 054例创伤性骨折患者进行回顾性研究。按超声筛查结果,分为深静脉血栓组188例,对照组866例,采用单因素和多因素logistic回归分析HDL-C水平与深静脉血栓形成的关系。结果深静脉血栓组的血清HDL-C水平低于对照组,HDL-C水平与深静脉血栓形成相关。HDL-C水平降低、年龄增大、制动时间增加、筛查前未用抗凝药时间增加、输血均是创伤性骨折患者深静脉血栓形成的危险因素;骨折部位不同,形成深静脉血栓的风险不同。深静脉血栓组和对照组中,手术患者较未行手术患者血清HDL-C水平降低。结论创伤性骨折患者血清HDL-C水平与深静脉血栓形成独立相关。
Objective To explore the association of plasma high density lipoprotein-cholesterol(HDL-C) and deep vein thrombosis(DVT) in traumatic fracture patients. Methods We performed a retrospective study in 1 054 traumatic fracture patients admitted between April 2012 and December 2014. 188 cases were divided into DVT and others(n=866) into control group based on ultrasound results. The relationship between HDL-C and DVT was determined by univariate and multivariate logistic regression analyses. Results Compared with control group, patients in DVT group had significantly lower HDL-C level, and low level of plasma HDL-C was associated with the occurrence of DVT. Deceased HDL-C, inceased age, inceased immobilization, inceasd anticoagulant-free days, fracture sites, and blood transfusion were risk factors for the occurrence of DVT in traumatic fracture patients. Patients with surgery had significantly lower level of HDL-C in both groups compared with patients without surgery respectively. Conclusion Low level of plasma HDL-C was independently associated with the occurrence of DVT in traumatic fracture patients.
Objective To explore the association of plasma high density lipoprotein-cholesterol(HDL-C) and deep vein thrombosis(DVT) in traumatic fracture patients. Methods We performed a retrospective study in 1 054 traumatic fracture patients admitted between April 2012 and December 2014. 188 cases were divided into DVT and others(n=866) into control group based on ultrasound results. The relationship between HDL-C and DVT was determined by univariate and multivariate logistic regression analyses. Results Compared with control group, patients in DVT group had significantly lower HDL-C level, and low level of plasma HDL-C was associated with the occurrence of DVT. Deceased HDL-C, inceased age, inceased immobilization, inceasd anticoagulant-free days, fracture sites, and blood transfusion were risk factors for the occurrence of DVT in traumatic fracture patients. Patients with surgery had significantly lower level of HDL-C in both groups compared with patients without surgery respectively. Conclusion Low level of plasma HDL-C was independently associated with the occurrence of DVT in traumatic fracture patients.
引文
[1] 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第3版). 中华普通外科杂志,2017,32(9):807-812.
[2] RIVA N, DONADINI MP, AGENO W. Epidemiology and pathophysiology of venous thromboembolism:similarities with atherothrombosis and the role of inflammation. Thromb Haemostasis,2015,113(6):1176-1183.
[3] BODEN WE. High-density lipoprotein cholesterol as an independent risk factor in cardiovascular disease:assessing the data from Framingham to the Veterans Affairs High-Density Lipoprotein Intervention Trial. Am J Cardiol,2000,86(12):19-22.
[4] DEGUCHI H, PECHENIUK NM, ELIAS DJ, et al. High-density lipoprotein deficiency and dyslipoproteinemia associated with venous thrombosis in men. Circulation,2005,112(6):893-899.
[5] FERRONI P, ROSELI M, RIONDINO S, et al. Predictive value of HDL cholesterol for cancer-associated venous thromboembolism during chemotherapy. J Thromb Haemost,2014,12(12):2049-2053.
[6] BRILL A, YESILALTAY A, DE MEYER SF, et al. Extrahepatic high-density lipoprotein receptor SR-BⅠ and apoA-Ⅰ protect against deep vein thrombosis in mice. Arterioscler Thromb Vas Biol,2012,32(8):1841-1847.
[7] VAN SCHOUWENBURG IM, MAHMOODI BK, GANSEVOORT RT, et al. Lipid levels do not influence the risk of venous thromboembolism. Thromb Haemostasis,2012,108(5):923-931.
[8] HEIT JA, SPENCER FA, WHITE RH. The epidemiology of venous thromboembolism. J Thromb Thrombolys,2016,41(1):3-14.
[9] PAYDAR S, SABETIAN G, KHALILI H, et al. Management of deep vein thrombosis (DVT) prophylaxis in trauma patients. Bull Emerg Trauma,2016,4(1):1-7.
[10] 陈国良, 刘立伟, 谢爽, 等. 高密度脂蛋白胆固醇代谢及其对冠心病影响的研究进展. 心血管病学进展,2010,31(3):360-363.
[11] MINEO C, DEGUCHI H, GRIFFIN JH, et al. Endothelial and antithrombotic actions of HDL. Circ Res,2006,98(11):1352-1364.
[12] VAN MDS, KORPORAA SJ, VAN EM. High-density lipoprotein as a modulator of platelet and coagulation responses. Cardiovasc Res,2014,103(3):362-371.
[13] REITSMA PH, VERSTEEG HH, MIDDELDORP S. Mechanistic view of risk factors for venous thromboembolism. Arterioscler Thromb Vas Biol,2012,32(3):563-568.
[14] VON BRUHL ML, STARK K, STEINHART A, et al. Monocytes, neutrophils, and platelets cooperate to initiate and propagate venous thrombosis in mice in vivo. J Exp Med,2012,209(4):819-835.
[15] PAFFRATH T, WAFAISADE A, LEFERING R, et al. Venous thromboembolism after severe trauma:incidence, risk factors and outcome. Injury,2010,41(1):97-101.
[2] RIVA N, DONADINI MP, AGENO W. Epidemiology and pathophysiology of venous thromboembolism:similarities with atherothrombosis and the role of inflammation. Thromb Haemostasis,2015,113(6):1176-1183.
[3] BODEN WE. High-density lipoprotein cholesterol as an independent risk factor in cardiovascular disease:assessing the data from Framingham to the Veterans Affairs High-Density Lipoprotein Intervention Trial. Am J Cardiol,2000,86(12):19-22.
[4] DEGUCHI H, PECHENIUK NM, ELIAS DJ, et al. High-density lipoprotein deficiency and dyslipoproteinemia associated with venous thrombosis in men. Circulation,2005,112(6):893-899.
[5] FERRONI P, ROSELI M, RIONDINO S, et al. Predictive value of HDL cholesterol for cancer-associated venous thromboembolism during chemotherapy. J Thromb Haemost,2014,12(12):2049-2053.
[6] BRILL A, YESILALTAY A, DE MEYER SF, et al. Extrahepatic high-density lipoprotein receptor SR-BⅠ and apoA-Ⅰ protect against deep vein thrombosis in mice. Arterioscler Thromb Vas Biol,2012,32(8):1841-1847.
[7] VAN SCHOUWENBURG IM, MAHMOODI BK, GANSEVOORT RT, et al. Lipid levels do not influence the risk of venous thromboembolism. Thromb Haemostasis,2012,108(5):923-931.
[8] HEIT JA, SPENCER FA, WHITE RH. The epidemiology of venous thromboembolism. J Thromb Thrombolys,2016,41(1):3-14.
[9] PAYDAR S, SABETIAN G, KHALILI H, et al. Management of deep vein thrombosis (DVT) prophylaxis in trauma patients. Bull Emerg Trauma,2016,4(1):1-7.
[10] 陈国良, 刘立伟, 谢爽, 等. 高密度脂蛋白胆固醇代谢及其对冠心病影响的研究进展. 心血管病学进展,2010,31(3):360-363.
[11] MINEO C, DEGUCHI H, GRIFFIN JH, et al. Endothelial and antithrombotic actions of HDL. Circ Res,2006,98(11):1352-1364.
[12] VAN MDS, KORPORAA SJ, VAN EM. High-density lipoprotein as a modulator of platelet and coagulation responses. Cardiovasc Res,2014,103(3):362-371.
[13] REITSMA PH, VERSTEEG HH, MIDDELDORP S. Mechanistic view of risk factors for venous thromboembolism. Arterioscler Thromb Vas Biol,2012,32(3):563-568.
[14] VON BRUHL ML, STARK K, STEINHART A, et al. Monocytes, neutrophils, and platelets cooperate to initiate and propagate venous thrombosis in mice in vivo. J Exp Med,2012,209(4):819-835.
[15] PAFFRATH T, WAFAISADE A, LEFERING R, et al. Venous thromboembolism after severe trauma:incidence, risk factors and outcome. Injury,2010,41(1):97-101.
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