Changes and Significance of D-D，F1+2 and P-selectin in Patients with Acute Deep Venous Thrombosis of Lower Extremities before and after Catheter-thrombolysis
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摘要:
目的 探究急性下肢深静脉血栓形成（DVT）患者置管溶栓前后D-二聚体（D-D）、凝血酶原片段1+2（F1+2）、P选择素（P-selectin）变化及临床意义。 方法 选取2020年3月至2022年3月云南省第三人民医院186例急性DVT患者作为研究对象，均行置管溶栓术，术后12个月以门诊形式进行随访，4例失访，共182例完成术后随访。根据术后12个月是否发生血栓后综合征（PTS）分为PTS组（n = 27）、非PTS组（n = 155），比较2组一般资料及溶栓前后血浆D-D、F1+2、P-selectin表达，Logistic分析PTS发生影响因素，受试者工作特征曲线（ROC）、曲线下面积（AUC）分析血浆D-D、F1+2、P-selectin预测PTS发生价值，采用相对危险度（RR）分析不同血浆D-D、F1+2、P-selectin表达对PTS的影响。 结果 PTS组年龄、BMI、静脉通畅评分及溶栓后1周、1个月血浆D-D、F1+2、P-selectin表达高于非PTS组（P < 0.05）；Logistic显示：BMI及溶栓后1周、1个月血浆D-D、F1+2、P-selectin是急性DVT患者发生PTS的影响因素（P < 0.05）；ROC曲线，溶栓后1个月血浆D-D、F1+2、P-selectin联合预测PTS效能明显优于溶栓后1周D-D、F1+2、P-selectin联合预测效能；溶栓后1个月血浆D-D、F1+2、P-selectin高表达患者发生PTS风险是低表达的4.211、2.550、3.189倍。 结论 急性DVT患者置管溶栓后血浆D-D、F1+2、P-selectin表达升高，其联合预测患者发生PTS具有一定预测效能。 -
关键词:
- 急性下肢深静脉血栓形成 /
- 置管溶栓术 /
- D-D /
- F1+2 /
- P-selectin
Abstract:Objective To explore the changes and clinical significance of D-dimer（D-D）, prothrombin fragment 1+2（F1+2） and P-selectin in patients with acute deep venous thrombosis of lower extremities（DVT） before and after catheterization and thrombolysis. Methods A total of 186 patients with acute DVT in the Third People's Hospital of Yunnan Province from March 2020 to March 2022 were selected as the study objects. And all of them underwent catheterization and hemolysis and were followed up in the outpatient form 12 months after the surgery. 4 cases were lost to follow-up, and a total of 182 cases completed postoperative follow-up. Postthrombotic syndrome（PTS） was divided into PTS group（n = 27） and non-PTS group（n = 155） according to whether post-thrombotic syndrome（PTS） occurred 12 months after the surgery. The general data of the two groups and the expression of D-D, F1+2, P-selectin in plasma before and after thrombolytic therapy were compared, and the influencing factors of PTS were analyzed by Logistic analysis. Receiver operating characteristic curve（ROC） and area under curve（AUC） were plotted to analyze the value of plasma D-D, F1+2, P-selectin in predicting the occurrence of PTS, and relative risk（RR） was used to analyze the influence of different plasma D-D, F1+2, P-selectin expression on PTS. Results Age, BMI, venous patency score, and plasma D-D, F1+2, P-selectin expression 1 week and 1 month after thrombolysis in PTS group were higher than those in non-PTS group（P < 0.05）. Logistic showed that BMI and plasma D-D, F1+2 and P-selectin 1 week and 1 month after thrombolysis were the influential factors for PTS in acute DVT patients（P < 0.05）. ROC curve showed that the combined efficacy of D-D, F1+2 and P-selectin 1 month after thrombolysis was significantly better than that of D-D, F1+2 and P-selectin 1 week after thrombolysis in predicting PTS. One month after thrombolysis, the risk of PTS in patients with high plasma D-D, F1+2, P-selectin expression was 4.211, 2.550 and 3.189 times higher than that in patients with low plasma D-D, F1+2, P-selectin expression. Conclusion The expression of D-D, F1+2 and P-selectin in plasma increases after thrombolysis in acute DVT patients, and the combination of D-D, F1+2 and P-selectin can predict the occurrence of PTS. -
Key words:
- Acute deep vein thrombosis of lower extremity /
- Catheter hemolysis /
- D-D /
- F1+2 /
- P-selectin
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图 1 血浆D-D、F1+2、P-selectin含量预测PTS发生价值
A：溶栓后1周血浆D-D、F1+2、P-selectin含量预测PTS发生价值；B：溶栓后1个月血浆D-D、F1+2、P-selectin含量预测PTS发生价值。
Figure 1. Value of plasma D-D，f1+2 and P-selectin contents in predicting the occurrence of PTS
表 1 2组一般资料、血浆D-D、F1+2、P-selectin表达[（$\bar x \pm s$）/n（%）]
Table 1. General data，plasma D-D，F1+2，P-selectin expression between the two groups [（$ \bar x \pm s $）/n（%）]
项目 PTS组（n=27） 非PTS组（n=155） t/χ2 P 男/女 15（55.56）/12（44.44） 89（57.42）/66（42.58） 0.033 0.857 年龄（岁） 68.65±6.11 60.12±5.34 7.494 <0.001* BMI（kg/m2） 24.89±0.96 21.15±0.87 20.298 <0.001* 病程（d） 7.34±1.20 7.21±1.38 0.460 0.646 溶栓时间（d） 5.10±0.52 4.95±0.63 1.169 0.244 尿激酶总用量（×104 U） 220.21±46.62 221.58±45.70 0.143 0.886 术中失血量（mL） 210.03±50.51 208.96±52.39 0.098 0.922 静脉通畅评分（分） 1.25±0.31 1.00±0.22 5.098 <0.001* 术后并发症 0.073 0.786 有/无 4（14.81）/23（85.19） 20（12.90）/135（87.10） 合并症 高血压/糖尿病/高脂血症 4（14.81）/6（22.22）/4（14.81） 18（11.61）/29（18.71）/16（10.32） 0.023/0.183/0.126 0.880/0.669/0.722 患肢 0.110 0.740 左侧/右侧 13（48.15）/14（51.85） 80（51.61）/75（48.39） 血栓分型 0.188 0.664 混合型/中央型 15（55.56）/12（44.44） 93（60.00）/62（40.00） D-D（ng/mL） 溶栓前 677.71±126.63 675.98±128.81 0.065 0.949 溶栓后1周 712.12±135.56 500.41±56.69 13.810 <0.001* 溶栓后1个月 1125.56±428.87 389.89±60.62 20.466 <0.001* F1+2（nmol/L） 溶栓前 1.65±0.38 1.57±0.49 0.806 0.421 溶栓后1周 1.86±0.42 1.13±0.26 12.128 <0.001* 溶栓后1个月 2.01±0.45 0.80±0.20 23.031 <0.001* P-selectin（ng/mL） 溶栓前 48.10±5.56 46.95±6.71 0.841 0.401 溶栓后1周 52.27±5.78 40.01±4.32 12.893 <0.001* 溶栓后1个月 60.56±6.12 31.12±3.86 33.130 <0.001* *P<0.05。 
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表 2 PTS发生影响因素
Table 2. Factors influencing the occurrence of PTS
自变量 β S.E. Waldχ2 P OR 95%CI 下限 上限 常量 −16.128 BMI 1.844 0.396 21.683 <0.001* 6.322 1.995 20.031 D-D 溶栓后1周 1.807 0.435 17.249 <0.001* 6.090 2.225 16.668 溶栓后1个月 1.379 0.289 22.765 <0.001* 3.970 1.123 14.038 F1+2 溶栓后1周 1.846 0.475 15.106 <0.001* 6.335 2.408 19.372 溶栓后1个月 1.641 0.342 23.016 <0.001* 5.159 1.896 16.665 P-selectin 溶栓后1周 1.767 0.455 15.089 <0.001* 5.856 2.001 17.137 溶栓后1个月 1.590 0.346 21.104 <0.001* 4.901 1.542 15.579 *P<0.05。
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表 3 血浆D-D、F1+2、P-selectin含量预测PTS发生价值
Table 3. Value of plasma D-D，F1+2 and P-selectin in predicting the occurrence of PTS
项目 AUC 95%CI 截断值 P 敏感度（%） 特异度（%） D-D（ng/mL） 溶栓后1周 0.767 0.699～0.826 693.40 <0.001* 62.96 84.52 溶栓后1个月 0.825 0.761～0877 1083.94 <0.001* 74.07 79.35 F1+2（nmol/mL） 溶栓后1周 0.800 0.735～0.856 1.76 <0.001* 70.37 84.52 溶栓后1个月 0.821 0.757～0.873 1.99 <0.001* 70.37 90.97 P-selectin（ng/mL） 溶栓后1周 0.745 0.675～0.807 52.05 <0.001* 62.96 83.87 溶栓后1个月 0.794 0.728～0.850 58.15 <0.001* 77.78 77.42 3者联合 溶栓后1周 0.893 0.839～0.934 − <0.001* 81.48 80.65 溶栓后1个月 0.936 0.890～0.967 − <0.001* 88.89 87.10 *P<0.05。
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表 4 不同血浆D-D、F1+2、P-selectin表达对PTS发生的影响[n（%）]
Table 4. Effects of different plasma D-D，F1+2，P-selectin expression on the occurrence of PTS[n（%）]
项目186 PTS组（n=27） 非PTS组（n=155） RR 95%CI P D-D 高表达（n=93） 22（81.48） 71（45.80） 4.211 1.667～10.635 <0.001* 低表达（n=89） 5（18.52） 84（54.20） F1+2 高表达（n=80） 18（66.67） 62（40.00） 2.550 1.211～5.370 0.008* 低表达（n=102） 9（33.33） 93（60.00） P-selectin 高表达（n=86） 20（74.07） 66（42.58） 3.189 1.418～7.170 0.002* 低表达（n=96） 7（25.93） 89（57.42） *P<0.05。
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