应用抗凝-纤溶标志物联合检测对髋关节置换术后静脉血栓进行诊断及疗效评估研究
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摘要
目的探讨TAT、PIC、TM及tPAI-C四个抗凝-纤溶标志物联合检测在髋关节置换术后静脉血栓的诊断效能及对疗效的评估价值。方法选取2017年10月至2018年3月于我院完成髋关节置换术的84例患者作为研究对象,根据是否并发静脉血栓分为实验组(并发)和对照组(未并发),分别为48例和36例。采用高敏化学发光法检测两组患者手术前后凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2纤溶酶抑制物复合物(PIC)、血栓调节蛋白(TM)及组织型纤溶酶原激活物抑制剂复合物(tPAI-C);绘制各单项和联合标志物对髋关节置换术后静脉血栓ROC曲线;统计实验组疗效,并分析抗凝-纤溶标志物与疗效之间的相关性。结果术前,两组患者各项抗凝-纤溶标志物差异无统计学意义(P>0. 05);术后,实验组各项抗凝-纤溶标志物均明显高于对照组,差异具有统计学意义(均P<0.001)。ROC曲线显示,各抗凝-纤溶单项标志物对髋关节置换术后静脉血栓均有一定的诊断价值,以t-PAI-C诊断效能最佳,余下依次为PIC、TAT及TM;与各单项检测比较,四组抗凝-纤溶标志物联合检测诊断效能明显提高。治疗后,经评估示实验组总有效者为45例,有效率为93.75%;经Pearson相关分析示,抗凝-纤溶标志物四组联合检测结果与术后静脉血栓疗效呈正相关(r=0. 715,P=0.006)。结论 TAT、PIC、TM及tPAI-C四个新型抗凝-纤溶标志物联合检测可明显提高髋关节置换术后静脉血栓的诊断效能,且与其疗效呈正相关,值得推广运用。
Objective To explore the diagnosis and efficiency evaluation value of the application of combined anticoagulation and fibrinolytic markers in venous thrombosis after hip replacement. Methods 84 cases of hip arthroplasty in our hospital from January 2014 to January 2017 were selected as the research subjects. They were then divided into the experimental group(concurrent) and the control group(uncomplicated), which were 48 cases and 36 cases respectively. The high sensitive chemiluminescence was used to detect the complex of thrombin antithrombin, plasmin inhibitor complex, thrombomodulin and tissue plasminogen activator inhibitor complex in the two groups of patients before and after the operation. The ROC curves of venous thrombosis after hip arthroplasty were plotted by single and combined markers. The effect of the experimental group was statistically analyzed, and the correlation between the anticoagulation fibrinolysis markers and the curative effect was analyzed. Results There were no significant differences in anticoagulation fibrinolytic markers between the two groups before the operation( P > 0. 05). After the operation, the anticoagulation fibrinolysis markers(TAT, PIC, TM and tPAI-C)in the experimental group were significantly higher than those of the control group,(P <0. 001). The ROC curve showed that all the anticoagulation and fibrinolysis markers had certain diagnostic value for the venous thrombosis after hip replacement. The diagnosis of t-PAI-C was the best,followed with PIC,TAT and TM. Compared with the individual tests, the combined detection of anticoagulation and fibrinolysis markers in the four groups improved significantly. After the treatment,45 cases were found to be effective in the experimental group,and the effective rate was 93.75%.Using the Person correlation analysis, the results of anticoagulation and fibrinolytic marker in the four groups were positively correlated with the effect of postoperative venous thrombosis(r = 0. 715, P = 0. 006).Conclusion The combined detection of four new anticoagulation and fibrinolytic markers(TAT, PIC, TM and tPAI-C)can significantly improve the diagnostic efficiency of venous thrombosis after hip replacement,and it has a positive correlation with its curative effect. The method is worth popularizing.
Objective To explore the diagnosis and efficiency evaluation value of the application of combined anticoagulation and fibrinolytic markers in venous thrombosis after hip replacement. Methods 84 cases of hip arthroplasty in our hospital from January 2014 to January 2017 were selected as the research subjects. They were then divided into the experimental group(concurrent) and the control group(uncomplicated), which were 48 cases and 36 cases respectively. The high sensitive chemiluminescence was used to detect the complex of thrombin antithrombin, plasmin inhibitor complex, thrombomodulin and tissue plasminogen activator inhibitor complex in the two groups of patients before and after the operation. The ROC curves of venous thrombosis after hip arthroplasty were plotted by single and combined markers. The effect of the experimental group was statistically analyzed, and the correlation between the anticoagulation fibrinolysis markers and the curative effect was analyzed. Results There were no significant differences in anticoagulation fibrinolytic markers between the two groups before the operation( P > 0. 05). After the operation, the anticoagulation fibrinolysis markers(TAT, PIC, TM and tPAI-C)in the experimental group were significantly higher than those of the control group,(P <0. 001). The ROC curve showed that all the anticoagulation and fibrinolysis markers had certain diagnostic value for the venous thrombosis after hip replacement. The diagnosis of t-PAI-C was the best,followed with PIC,TAT and TM. Compared with the individual tests, the combined detection of anticoagulation and fibrinolysis markers in the four groups improved significantly. After the treatment,45 cases were found to be effective in the experimental group,and the effective rate was 93.75%.Using the Person correlation analysis, the results of anticoagulation and fibrinolytic marker in the four groups were positively correlated with the effect of postoperative venous thrombosis(r = 0. 715, P = 0. 006).Conclusion The combined detection of four new anticoagulation and fibrinolytic markers(TAT, PIC, TM and tPAI-C)can significantly improve the diagnostic efficiency of venous thrombosis after hip replacement,and it has a positive correlation with its curative effect. The method is worth popularizing.
引文
[1]向川,郝耀,杨宇君,等.人工髋关节置换术与内固定术治疗老年股骨粗隆间骨折的META分析[J].中国矫形外科杂志,2013,21(14):1384-1391.
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[10]赵辉,吴海山,吴宇黎,等.延长疗程利伐沙班预防初次髋关节置换术后静脉血栓栓塞症的临床观察[J].中华骨与关节外科杂志,2016,9(1):31-34.
[11]李明,吴小鹏,王志青.下肢深静脉血栓形成手术时机的探讨[J].中国现代普通外科进展,2006,9(4):243-244.
[12]魏长月.骨科创伤手术后患者并发下肢深静脉血栓的预防和治疗护理观察[J].中国实用医药,2016,11(10):238-239.
[13]陈哲,郭艳幸.髋膝关节置换术后应用药物预防下肢深静脉血栓的研究进展[J].临床研究,2016,24(1):186-187.
[14]钱秋然,殷鸿雁.F1+2、TAT、AT-Ⅲ、D-Dimer水平在早期复发性流产预测中的临床价值[J].实用妇科内分泌杂志(电子版),2017,4(1):3-4.
[15]聂晶,孔英君.血栓调节蛋白在肺血栓栓塞症、急性呼吸窘迫综合征及肺癌中的作用研究进展[J].中华临床医师杂志(电子版),2013,7(21):9665-9667.
[16]刘大宁,张丽媛,刘尧.不同类型肺癌患者血凝血与纤溶指标水平分析[J].河南医学研究,2017,26(9):1573-1574.
[17]吕永楠,任玮,陈晶晶,等.急性心肌梗死患者血栓标志物水平变化及意义[J].微循环学杂志,2017,27(3):43-46.
[18]丁萌,张青云,景阳,等.D-二聚体和纤维蛋白原联合检测在下肢深静脉血栓诊断中的应用价值[J].第三军医大学学报,2016,38(16):1885-1888.
[2] LYMAN S,LEE Y Y, FRANKLIN P D, et al. Validation of the HOOS,JR:a short-form hip replacement survey[J]. Clin Orthop Relat Res,2016.474(6):1472-1482.
[3] TSUKANAKA M, HALVORSEN V, NORDSLETTEN L, et al.Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old[J]. Acta Orthop, 2016,87(5):479-484.
[4]刘刚,袁东堂,于广洋,等.髋关节置换术后中位生存时间及相关预后影响因素分析[J].实用骨科杂志,2016,22(1):28-32.
[5]杨利,张俊.早期量化康复训练及居家护理模式对老年人工髋关节置换术患者预后影响因素分析[J].中国伤残医学,2017,25(6):10-13.
[6]马睿,任静,门剑龙.血栓风险标志物在癌症相关静脉血栓栓塞症监测中的研究进展[J].临床检验杂志,2017,35(12):942-945.
[7]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2版)[J].中国医学前沿杂志(电子版),2013,5(3):53-57.
[8]王深明,武日东.下肢深静脉血栓形成治疗指南与实践[J].中国实用外科杂志,2015,35(12):1264-1266.
[9]白璐,白俊清,王国立.中老年外伤性人工髋关节置换术后深静脉血栓的早期实验诊断研究[J].首都医科大学学报,2016,37(2):223-227.
[10]赵辉,吴海山,吴宇黎,等.延长疗程利伐沙班预防初次髋关节置换术后静脉血栓栓塞症的临床观察[J].中华骨与关节外科杂志,2016,9(1):31-34.
[11]李明,吴小鹏,王志青.下肢深静脉血栓形成手术时机的探讨[J].中国现代普通外科进展,2006,9(4):243-244.
[12]魏长月.骨科创伤手术后患者并发下肢深静脉血栓的预防和治疗护理观察[J].中国实用医药,2016,11(10):238-239.
[13]陈哲,郭艳幸.髋膝关节置换术后应用药物预防下肢深静脉血栓的研究进展[J].临床研究,2016,24(1):186-187.
[14]钱秋然,殷鸿雁.F1+2、TAT、AT-Ⅲ、D-Dimer水平在早期复发性流产预测中的临床价值[J].实用妇科内分泌杂志(电子版),2017,4(1):3-4.
[15]聂晶,孔英君.血栓调节蛋白在肺血栓栓塞症、急性呼吸窘迫综合征及肺癌中的作用研究进展[J].中华临床医师杂志(电子版),2013,7(21):9665-9667.
[16]刘大宁,张丽媛,刘尧.不同类型肺癌患者血凝血与纤溶指标水平分析[J].河南医学研究,2017,26(9):1573-1574.
[17]吕永楠,任玮,陈晶晶,等.急性心肌梗死患者血栓标志物水平变化及意义[J].微循环学杂志,2017,27(3):43-46.
[18]丁萌,张青云,景阳,等.D-二聚体和纤维蛋白原联合检测在下肢深静脉血栓诊断中的应用价值[J].第三军医大学学报,2016,38(16):1885-1888.