血脂与下肢深静脉血栓的相关性研究
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摘要
【目的】
本文通过对108例下肢深静脉血栓患者和100例对照患者的血脂水平的研究,探讨血脂的各项指标和下肢深静脉血栓形成的关系。
1.探讨血脂的各项指标,包括:胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、氧化型低密度脂蛋白和脂蛋白(a)等,与下肢深静脉血栓的关系。
2.如何根据血脂的水平估计形成下肢深静脉血栓的危险性,以更好的预防下肢深静脉血栓的形成。
【方法】
1.首先在我院随机选择骨牵引患者120例,作为实验组,再随机选择同期同等条件下的非牵引患者100例,作为对照组,分别统计出实验组和对照组患者出现下肢深静脉血栓的发病率,对两组患者的下肢深静脉血栓的发病率进行统计学分析,得出结果,进而了解骨牵引对下肢深静脉血栓形成是否有的影响。
2.将108例外伤后卧床制动2周内形成下肢深静脉血栓的患者(实验组)分为两组:牵引组(B1组)和非牵引组(B2组),再将100例未出现下肢深静脉血栓的患者(对照组)也分为两组:牵引组(A1组)和非牵引组(A2组)。分别对其外伤卧床制动后1天,1周和2周的血脂水平进行回顾性分析,包括:胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、氧化型低密度脂蛋白和脂蛋白(a)。首先进行组内比较,以了解牵引是否对实验结果有影响;再通过组间比较,了解血脂的各项指标与下肢深静脉血栓的关系。
【结果】
1.在骨牵引组的120例患者当中,出现下肢深静脉血栓的患者为20例,其血栓发病率为16.7%,而在非牵引组的100例患者当中,出现下肢深静脉血栓的患者为15例,其血栓发病率为15.0%。通过χ~2检验,测得χ~2值为0.113(P＞0.05),尚不能认为两组患者的血栓发病率不同。
2.通过A1组与B1组和A2组与B2组的比较表明:胆固醇和甘油三酯各时段水平,实验组与对照组均无差异;而氧化型低密度脂蛋白在外伤卧床制动后各时段水平,实验组均明显高于对照组;低密度脂蛋白、高密度脂蛋白在外伤卧床制动后2周时的水平,实验组明显高于和低于对照组;脂蛋白(a)在外伤卧床制动后1周和2周时的水平,实验组均明显高于对照组。
【结论】
1.骨牵引不能作为下肢深静脉血栓形成的诱发因素,没有对下肢深静脉血栓形成造成影响。
2.胆固醇和甘油三酯水平的升高对与下肢深静脉血栓的形成无影响。
3.氧化型低密度脂蛋白、脂蛋白(a)、低密度脂蛋白和高密度脂蛋白水平的升高对下肢深静脉血栓的形成有着明显的相关性,尤其是氧化型低密度脂蛋白是下肢深静脉血栓的形成的重要因素,对静脉血栓形成有重要意义。
4.对于氧化型低密度脂蛋白水平升高的患者应积极预防下肢深静脉血栓的形成,以免造成肺栓塞等严重后果,危及生命。而脂蛋白(a)、低密度脂蛋白和高密度脂蛋白水平可以作为指导预防和治疗下肢深静脉血栓形成的辅助指标。
[Objective]
To explore the relationship between the lipid indexes and deep vein thrombosis (DVT) of lower extremity by the study of the lipid indexes between 108 patients of DVT of lower extremity and 100 patients as compared group.
1. To understand the relationship between every indexes of the lipid such as: CHOL, TRIG, LDL, HDL, LDL and ox-Lp (a), and DVT of lower extremity.
2. How to evaluate the danger of DVT of lower extremity and to carry out it better according to the level of the lipid indexes.
[Methods]
1. First 120 patients of traction was random selected in hospital, as experimental group; and 100 patients of non-traction was random selected in the same time and condition, as control group. Than the incidence of DVT of lower extremity of the two groups was analyzed statically, draw the conclusion, and then understand if traction can affect the incidence of DVT of lower extremity.
2.108 patients who were in bed after injury formed DVT of lower extremity within two weeks, were divided into two groups (experimental group): traction group (B1) and non-traction group (B2), and there were 100 patients who didn't form DVT of lower extremity were divided into two groups (control group): traction group (A1) and non-traction group (A2). The lipid level of these patients who were in bed after injury one day, one week and two weeks were analyzed retrospectively, including: CHOL, TRIG, LDL, HDL, ox-LDL and Lp(a). First, we can understand the affection of traction by compare between the group Al and A2 and group B1 and B2, than we can understand the relationship by compare differences of lipids in the various indicators of between the various groups.
[Results]
1. Among the 120 patients of group traction there were 20 patients suffer from DVT of lower extremity, incidence of DVT of lower extremity was 16.7%; Among the 100 patients of group non-traction there were 15 patients suffer from DVT of lower extremity, incidence of DVT of lower extremity was 15%. By chi square test, X~2=0.113(P>0.05), so we can't consider incidence of DVT of lower extremity of the two groups is different.
2. Compared between group A1 and B1 and between group A2 and B2 showed that: CHOL and TRIG, there were no different between the experimental group and the control group; but level of ox-LDL of the experimental group was significantly higher than the control group, the experimental group; level of LDL and HDL of the experimental group after two weeks was significantly higher and lower than the level of the control group; level of Lp (a) of the experimental group after one week and two weeks was significantly higher than the control group.
[Conclusions]
1. It is not regarded induced factor of DVT of lower extremity that bone was tracked, and it doesn't affect DVT of lower extremity.
2. CHOL and TRIG have no relevance with DVT of lower extremity.
3. The increase of Ox-LDL, LDL, HDL and Lp (a) levels have relevance with DVT of lower extremity, in particular ox-LDL have significantly relevance with DVT of lower extremity, it is an important factor in the formation of venous thrombosis and has great significance .
4. To higher Ox-LDL level patients elevated should actively prevent the formation of DVT of lower extremity, so as to avoid serious consequences, such as pulmonary embolism, a life-threatening. And LDL, HDL and Lp (a) levels can be used as auxiliary indicator to the prevention of DVT of lower extremity.
本文通过对108例下肢深静脉血栓患者和100例对照患者的血脂水平的研究,探讨血脂的各项指标和下肢深静脉血栓形成的关系。
1.探讨血脂的各项指标,包括:胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、氧化型低密度脂蛋白和脂蛋白(a)等,与下肢深静脉血栓的关系。
2.如何根据血脂的水平估计形成下肢深静脉血栓的危险性,以更好的预防下肢深静脉血栓的形成。
【方法】
1.首先在我院随机选择骨牵引患者120例,作为实验组,再随机选择同期同等条件下的非牵引患者100例,作为对照组,分别统计出实验组和对照组患者出现下肢深静脉血栓的发病率,对两组患者的下肢深静脉血栓的发病率进行统计学分析,得出结果,进而了解骨牵引对下肢深静脉血栓形成是否有的影响。
2.将108例外伤后卧床制动2周内形成下肢深静脉血栓的患者(实验组)分为两组:牵引组(B1组)和非牵引组(B2组),再将100例未出现下肢深静脉血栓的患者(对照组)也分为两组:牵引组(A1组)和非牵引组(A2组)。分别对其外伤卧床制动后1天,1周和2周的血脂水平进行回顾性分析,包括:胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、氧化型低密度脂蛋白和脂蛋白(a)。首先进行组内比较,以了解牵引是否对实验结果有影响;再通过组间比较,了解血脂的各项指标与下肢深静脉血栓的关系。
【结果】
1.在骨牵引组的120例患者当中,出现下肢深静脉血栓的患者为20例,其血栓发病率为16.7%,而在非牵引组的100例患者当中,出现下肢深静脉血栓的患者为15例,其血栓发病率为15.0%。通过χ~2检验,测得χ~2值为0.113(P＞0.05),尚不能认为两组患者的血栓发病率不同。
2.通过A1组与B1组和A2组与B2组的比较表明:胆固醇和甘油三酯各时段水平,实验组与对照组均无差异;而氧化型低密度脂蛋白在外伤卧床制动后各时段水平,实验组均明显高于对照组;低密度脂蛋白、高密度脂蛋白在外伤卧床制动后2周时的水平,实验组明显高于和低于对照组;脂蛋白(a)在外伤卧床制动后1周和2周时的水平,实验组均明显高于对照组。
【结论】
1.骨牵引不能作为下肢深静脉血栓形成的诱发因素,没有对下肢深静脉血栓形成造成影响。
2.胆固醇和甘油三酯水平的升高对与下肢深静脉血栓的形成无影响。
3.氧化型低密度脂蛋白、脂蛋白(a)、低密度脂蛋白和高密度脂蛋白水平的升高对下肢深静脉血栓的形成有着明显的相关性,尤其是氧化型低密度脂蛋白是下肢深静脉血栓的形成的重要因素,对静脉血栓形成有重要意义。
4.对于氧化型低密度脂蛋白水平升高的患者应积极预防下肢深静脉血栓的形成,以免造成肺栓塞等严重后果,危及生命。而脂蛋白(a)、低密度脂蛋白和高密度脂蛋白水平可以作为指导预防和治疗下肢深静脉血栓形成的辅助指标。
[Objective]
To explore the relationship between the lipid indexes and deep vein thrombosis (DVT) of lower extremity by the study of the lipid indexes between 108 patients of DVT of lower extremity and 100 patients as compared group.
1. To understand the relationship between every indexes of the lipid such as: CHOL, TRIG, LDL, HDL, LDL and ox-Lp (a), and DVT of lower extremity.
2. How to evaluate the danger of DVT of lower extremity and to carry out it better according to the level of the lipid indexes.
[Methods]
1. First 120 patients of traction was random selected in hospital, as experimental group; and 100 patients of non-traction was random selected in the same time and condition, as control group. Than the incidence of DVT of lower extremity of the two groups was analyzed statically, draw the conclusion, and then understand if traction can affect the incidence of DVT of lower extremity.
2.108 patients who were in bed after injury formed DVT of lower extremity within two weeks, were divided into two groups (experimental group): traction group (B1) and non-traction group (B2), and there were 100 patients who didn't form DVT of lower extremity were divided into two groups (control group): traction group (A1) and non-traction group (A2). The lipid level of these patients who were in bed after injury one day, one week and two weeks were analyzed retrospectively, including: CHOL, TRIG, LDL, HDL, ox-LDL and Lp(a). First, we can understand the affection of traction by compare between the group Al and A2 and group B1 and B2, than we can understand the relationship by compare differences of lipids in the various indicators of between the various groups.
[Results]
1. Among the 120 patients of group traction there were 20 patients suffer from DVT of lower extremity, incidence of DVT of lower extremity was 16.7%; Among the 100 patients of group non-traction there were 15 patients suffer from DVT of lower extremity, incidence of DVT of lower extremity was 15%. By chi square test, X~2=0.113(P>0.05), so we can't consider incidence of DVT of lower extremity of the two groups is different.
2. Compared between group A1 and B1 and between group A2 and B2 showed that: CHOL and TRIG, there were no different between the experimental group and the control group; but level of ox-LDL of the experimental group was significantly higher than the control group, the experimental group; level of LDL and HDL of the experimental group after two weeks was significantly higher and lower than the level of the control group; level of Lp (a) of the experimental group after one week and two weeks was significantly higher than the control group.
[Conclusions]
1. It is not regarded induced factor of DVT of lower extremity that bone was tracked, and it doesn't affect DVT of lower extremity.
2. CHOL and TRIG have no relevance with DVT of lower extremity.
3. The increase of Ox-LDL, LDL, HDL and Lp (a) levels have relevance with DVT of lower extremity, in particular ox-LDL have significantly relevance with DVT of lower extremity, it is an important factor in the formation of venous thrombosis and has great significance .
4. To higher Ox-LDL level patients elevated should actively prevent the formation of DVT of lower extremity, so as to avoid serious consequences, such as pulmonary embolism, a life-threatening. And LDL, HDL and Lp (a) levels can be used as auxiliary indicator to the prevention of DVT of lower extremity.
引文
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[4]Lip GY,Blant A.Does hypertension confer a prethromboticstate virchows triad revisited[J].Circulation,2006,101(3):2182-2201.
[5]Yamazaki M,Uchiyama S,Iwata M.Measurement of platelet fibrinogen binding and pselectin expression by flow cytometry in patients with cerebral infarction[J].ThrombRes,2005,104(3):197-205.
[6]Preston RA,J imenez JJ,et all.Effects of severe hypertension on endothelial and platelet microparticles-1 Hypertension,2003,41(2):2112-2171
[7]关永源,林默君.一氧化氮的药理学作用新医学[J],1999,130(1):552-571.
[8]王淑娟.关于选择血栓前状态实验诊断指标的建议[J].中华医学检验杂志,2004,21(5):305-307.
[9]许文亮,郭新贵,徐延路,等.下肢深静脉血栓形成患者血浆胆固醇与内皮素C反应蛋白及血小板可溶性P选择素相关性研究[J].新医学,2004,35(2):587-590.
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[1]RoBert B,Ford R.Vascular surgery[M].北京:人民卫生出版社,第一版,2002:1937-1941.
[2]Camillettia,Morettin,Giacchetti G,et all.Decreased nitric oxide levels and increased calcium content in platelets of hypertensive patients Am J Hypertens[J],2005,14(41):382-386.
[3]Enrico Bernadi.Extended versus rapid analysis of the leg veinsystem:a multicenter ultrasound study[J].Pathophysiol H aem ostThromb,2004,33:314-318.
[4]Lip GY,Blant A.Does hypertension confer a prethromboticstate virchows triad revisited[J].Circulation,2006,101(3):2182-2201.
[5]Yamazaki M,Uchiyama S,Iwata M.Measurement of platelet fibrinogen binding and pselectin expression by flow cytometry in patients with cerebral infarction[J].ThrombRes,2005,104(3):197-205.
[6]Preston RA,J imenez JJ,et all.Effects of severe hypertension on endothelial and platelet microparticles-1 Hypertension,2003,41(2):2112-2171
[7]关永源,林默君.一氧化氮的药理学作用新医学[J],1999,130(1):552-571.
[8]王淑娟.关于选择血栓前状态实验诊断指标的建议[J].中华医学检验杂志,2004,21(5):305-307.
[9]许文亮,郭新贵,徐延路,等.下肢深静脉血栓形成患者血浆胆固醇与内皮素C反应蛋白及血小板可溶性P选择素相关性研究[J].新医学,2004,35(2):587-590.
[10]万仑,胡豇,刘仲前.骨水泥对全髋置换术后深静脉血栓形成的影响[J].四川医学,2002,23(8):798-799.
[11]Ross GM,McMillan TJ,Wilcox P,et al.The single cell microgel elect rophoresis assay(comet assay):technical aspects and applications.Report on the 5th LH Gray TrustWorkshop,Institute of Cancer Research[J],Mutat Res,2005,337(1):57-60.
[12]Wen F,Yu SZ.A study on the content ofCSF vWF in patient s with cerebral infarction at different location[J].ThrombHaemost,2006,88(6):1067-1068.
[13]Loscalzo J Nitric oxide insufficiency,platelet activation,and arterial thrombosis[J].Circ Res,2005,88(8):756-762.
[14]中国高血压防治指南起草委员会中国高血压防治指南[J].高血压杂志,2000,8(1):941.
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[16]Christie J,Burnett R,Potts HR,et al.Echocardiography of transtrial embolism during cemented and uncemented hemiartheroplasty of the hip[J].JBone Joint Surg Br,2005,76(3):409-412.
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[18]孙英信,时德,向志,等.急性下肢静脉血栓形成148例的治疗[J].第四军医大学学报,2005,23(9):813-814.
[19]Murohara T,Scalia R,Lefer AM.Lysophosphatidylcholine promotes P selectin expression in platelets and endothelial cells.Possible involvement of protein kinase C activation and its inhibition by nitric oxide donors[J].Circ Res,2004,78(5):892-897.
[20]Omi H,Okayama N,Shinizu M,et al.Cilostazol inhibits high glucose mediated endothelialneutrophil adhesion by decreasing adhesion mole cule exp ression via NO production[J].Microvascular Research,2004,68(2):119-125.