髋关节置换术围手术期P-选择素对下肢深静脉血栓预测的临床研究
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摘要
目的探讨P—选择素在单髋关节置换术后深静脉血栓(Deep venous thrombosis, DVT)形成中的临床诊断价值及其适合的诊断临界值。
方法选择2007年10月-2010年3月在我院行单髋关节置换术的102例住院病人,手术入路均采用髋关节外侧切口,病人术前及术后2、4、7天或随访发现患肢肿胀不消退行患肢深静脉彩超检查,正常对照组为同期来我院做体检的健康者,共50例；根据术后彩超检查结果将病人分为DVT组与非DVT组,与健康对照组比较。收集病人术前术后及健康对照组清晨空腹血浆,采用酶联免疫双抗体夹心法测定血浆P-选择素含量,用SPSS和originPro8.0统计学软件进行数据分析及绘制接受者操作特性曲线(Receiver operating characteristic curve, ROC)。
结果术前DVT组与非DVT组、健康对照组P—选择素含量的差异无统计学意义,术后DVT组与非DVT组P-选择素含量存在统计学差异；应用SPSS11.0软件算出ROC曲线下的面积AUC为0.716；以不同临界点时的敏感度为纵坐标、1-特异度为横坐标,应用originPro8.0统计软件,作图得到ROC曲线,选取曲线图中最左上方的点对应的值结合敏感度确定最佳诊断临界值为42 ng·mL-1。
结论P—选择素对髋关节置换术围手术期深静脉血栓的形成具有较高的预测与诊断价值；当P—选择素>42 ng·mL-1时可诊断DVT的形成。
Objective:To investigate the value of clinical diagnosis and threshold for the diagnosis on P-selectin during perioperative hip replacement.
Methods:Select the 102 patients with single hip replacement in the hospital from October 2007 to March 2010, Surgical approaches are used lateral hip incision; The patients with the preoperative and postoperative 2、4、7 days or the limb swelling does not go away need the deep venous color dppler examination, Normal control group are the 50 healthy people with the same period in our hospital.according to color doppler examination,the patients were divided into DVT group and non-DVT group, which compared with the healthy group. Collect the plasma of patients who are fasting before and after operation early in the morning; Determinate the content of the P-selectin in plasma by ELISA (Enzyme linked immunosorbent assay) and draw ROC curves (Receiver operating characteristic curve)in patients after hip replacement using the SPSS and the originPro8.0.
Results:There was no statistical difference on the content of the P-selectin between the DVT group and the non-DVT group and the Normal control group before surgery, but there was statistics different after surgery. the AUC (Area under the curve)is 0.716 using the SPSS 11.0. Draw the ROC curve using the originPro8.0 with the sensitivity for the vertical and 1-specificity for the horizontal in a different point.Determine the 42 ng·mL-1 as the best diagnostic threshold, through selecting the top-left point in the curve and combinning the sensitivity.
Conclusion:P-selectin play an important early warning role and diagnosis in DVT during perioperative hip replacement.It was the>42 ng·mL-1 for the diagnosis of the DVT as the best threshold.
方法选择2007年10月-2010年3月在我院行单髋关节置换术的102例住院病人,手术入路均采用髋关节外侧切口,病人术前及术后2、4、7天或随访发现患肢肿胀不消退行患肢深静脉彩超检查,正常对照组为同期来我院做体检的健康者,共50例；根据术后彩超检查结果将病人分为DVT组与非DVT组,与健康对照组比较。收集病人术前术后及健康对照组清晨空腹血浆,采用酶联免疫双抗体夹心法测定血浆P-选择素含量,用SPSS和originPro8.0统计学软件进行数据分析及绘制接受者操作特性曲线(Receiver operating characteristic curve, ROC)。
结果术前DVT组与非DVT组、健康对照组P—选择素含量的差异无统计学意义,术后DVT组与非DVT组P-选择素含量存在统计学差异；应用SPSS11.0软件算出ROC曲线下的面积AUC为0.716；以不同临界点时的敏感度为纵坐标、1-特异度为横坐标,应用originPro8.0统计软件,作图得到ROC曲线,选取曲线图中最左上方的点对应的值结合敏感度确定最佳诊断临界值为42 ng·mL-1。
结论P—选择素对髋关节置换术围手术期深静脉血栓的形成具有较高的预测与诊断价值；当P—选择素>42 ng·mL-1时可诊断DVT的形成。
Objective:To investigate the value of clinical diagnosis and threshold for the diagnosis on P-selectin during perioperative hip replacement.
Methods:Select the 102 patients with single hip replacement in the hospital from October 2007 to March 2010, Surgical approaches are used lateral hip incision; The patients with the preoperative and postoperative 2、4、7 days or the limb swelling does not go away need the deep venous color dppler examination, Normal control group are the 50 healthy people with the same period in our hospital.according to color doppler examination,the patients were divided into DVT group and non-DVT group, which compared with the healthy group. Collect the plasma of patients who are fasting before and after operation early in the morning; Determinate the content of the P-selectin in plasma by ELISA (Enzyme linked immunosorbent assay) and draw ROC curves (Receiver operating characteristic curve)in patients after hip replacement using the SPSS and the originPro8.0.
Results:There was no statistical difference on the content of the P-selectin between the DVT group and the non-DVT group and the Normal control group before surgery, but there was statistics different after surgery. the AUC (Area under the curve)is 0.716 using the SPSS 11.0. Draw the ROC curve using the originPro8.0 with the sensitivity for the vertical and 1-specificity for the horizontal in a different point.Determine the 42 ng·mL-1 as the best diagnostic threshold, through selecting the top-left point in the curve and combinning the sensitivity.
Conclusion:P-selectin play an important early warning role and diagnosis in DVT during perioperative hip replacement.It was the>42 ng·mL-1 for the diagnosis of the DVT as the best threshold.
引文
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