摘要
目的探究血浆D-二聚体(D-D)、血浆内皮素(ET)与血栓素B2(TXB2)水平对脊柱退行性变患者术后深静脉血栓栓塞症(DVT)的预测价值。方法选取2018年1月至2019年1月在本院接受治疗的134例脊柱退行性变患者作为研究对象,根据术后1个月彩色多普勒超声检查是否发生DVT分为DVT组(55例)和无DVT组(79例)。比较两组患者术前1 d和术后1、3、7 d血浆D-D、ET与TXB2水平,并采用受试者工作特征曲线(ROC)分析术后1、3、7 d血浆D-D、ET与TXB2水平对脊柱退行性变患者术后DVT的预测价值。结果重复测量方差分析结果显示,时点效应可以影响D-D水平的变化(P<0.05),组间效应可以影响D-D、ET、TXB2水平的变化(P<0.05),时点和组间的交互效应可以影响D-D、ET水平的变化(P<0.05);事后多重比较显示,两组患者术后1 d的D-D、ET、TXB2水平均高于术前1 d,DVT组术后3 d的D-D、ET、TXB2水平均高于术前1 d,术后7 d的D-D、ET水平均高于术前1 d,无DVT组术后3、7 d的D-D水平均高于术前1 d,术后1、3、7 d的DVT组D-D、ET、TXB2水平均高于无DVT组(P均<0.05)。ROC曲线分析显示,术后1 d的D-D、ET、TXB2预测术后DVT的AUC分别为0.905、0.792、0.678,Cut-off值分别为1.605μg·mL^(-1)、72.395 ng·mL^(-1)、145.225 ng·L^(-1),灵敏度分别为80.0%、50.9%、50.9%,特异度分别为91.1%、98.7%、92.4%;术后3 d的D-D、ET、TXB2预测术后DVT的AUC分别为0.990、0.749、0.597,Cut-off值分别为1.920μg·mL^(-1)、60.995 ng·mL^(-1)、140.280 ng·L^(-1),灵敏度分别为94.5%、52.7%、43.6%,特异度分别为100.0%、89.9%、78.5%;术后7 d的D-D、ET、TXB2预测术后DVT的AUC分别为0.796、0.685、0.557,Cut-off值分别为1.670μg·mL^(-1)、40.550 ng·mL^(-1)、141.685 ng·L^(-1),灵敏度分别为56.4%、89.1%、34.5%,特异度分别为89.9%、48.1%、83.5%。结论术后1、3、7 d血浆D-D、ET与TXB2水平均对脊柱退行性变术后患者DVT有预测价值,且D-D预测的最佳时间点为术后3 d,ET、TXB2预测的最佳时间点为术后1 d。
Objective To explore the predictive value of plasma D-dimer(D-D),plasma endothelin(ET)and thromboxane B2(TXB2)levels for postoperative deep vein thromboembolism(DVT)in patients with spinal degeneration.Methods 134 patients with spinal degeneration who were treated in our hospital from January 2018 to January 2019 were selected as the research objects.According to whether DVT occurred in color Doppler ultrasound examination 1 month after operation,they were divided into two groups,with 55 patients in DVT group and 79 patients in the non-DVT group.The plasma D-D,ET,and TXB2 levels were compared between the two groups of patients 1 d before operation and 1,3 and 7 d after operation,and the receiver operating characteristic curve(ROC)was used to analyze the plasma D-D,ET,and TXB2 levels at 1,3 and 7 d after operation.The predictive value of postoperative DVT in patients with spinal degeneration was investigated.Results Repeated measures analysis of variance showed that the time point effect could significantly affect the change of D-D level(P<0.05),the inter-group effect could significantly affect the change of D-D,ET,TXB2 levels(P<0.05),the time point and the interaction between groups could significantly affect the changes of D-D and ET levels(P<0.05);multiple comparisons afterwards showed that the levels of D-D,ET and TXB2 on the first day after surgery in the two groups were higher than those on the first day before surgery.In the DVT group,the levels of D-D,ET and TXB2 on the 3 d after surgery were T higher than 1 d before operation,and the levels of D-D and ET on 7 d after operation were higher than those at 1 d before operation.The levels of D-D at 3 d and 7 d after operation were higher than that of 1 d before operation in the group without DVT.The levels of D-D,ET,TXB2 at 1,3 and 7 d after operation were higher than those without DVT(P all<0.05).ROC curve analysis showed that the AUC of D-D,ET and TXB2 predicting postoperative DVT at 1 d after operation were 0.905,0.792,and 0.678,respectively,and the Cut-off values were 1.605μg·mL^(-1),72.395 ng·mL^(-1) and 145.225 ng·L^(-1),respectively,the sensitivity were 80.0%,50.9%and 50.9%,respectively,and the specificities were 91.1%,98.7%and 92.4%,respectively.The AUC of postoperative DVT predicted by D-D,ET and TXB2 at 3 d after operation were 0.990,0.749 and 0.597 respectively,and Cut-off value were 1.920μg·mL^(-1),60.995 ng·mL^(-1),140.280 ng·L^(-1),the sensitivity was 94.5%,52.7%,43.6%,and the specificity was 100.0%,89.9%,78.5%.7 d after operation,D-D,ET,TXB2 predicted postoperative DVT AUC of 0.796,0.685,0.557,Cut-off values were 1.670μg·mL^(-1),40.550 ng·mL^(-1),141.685 ng·L^(-1),sensitivity were 56.4%,89.1%,34.5%,the specificity was 89.9%,48.1%and 83.5%respectively.Conclusion Plasma D-D,ET,and TXB2 levels at 1,3 and 7 d after surgery have predictive value for postoperative DVT in patients with spinal degenerative diseases,and the best time point for D-D prediction is 3 d after surgery,and the best time point for ET and TXB2 prediction is 1 d after operation.
作者
宫树一
王景续
穆胜凯
GONG Shuyi;WANG Jingxu;MU Shengkai(Department of Spine Surgery,Shenyang Orthopedic Hospital,Shenyang 110000,China)
出处
《宁夏医科大学学报》
2022年第8期774-778,共5页
Journal of Ningxia Medical University
基金
辽宁省自然科学基金指导计划项目(20180550704)。
