摘要
目的分析凝血-纤溶失衡与老年下肢深静脉血栓严重程度的关系及其对肺栓塞的预测效能。方法回顾性选择2019年1月至2022年6月攀枝花市中心医院收治的102例老年下肢深静脉血栓患者作为观察组,根据是否出现临床症状细分为有症状组(45例)和无症状组(57例),另选102名健康体检者作为对照组。检测所有受试者血浆凝血酶-抗凝血酶复合物(TAT)和纤溶酶-α2纤溶酶抑制物复合物(PIC),以TAT/PIC比值作为评价凝血-纤溶失衡程度的指标。对病变血管进行超声评分和Villalta评分,观察肺栓塞发生情况。采用受试者工作特征(ROC)曲线分析TAT/PIC比值、超声评分和Villalta评分的关系及其对肺栓塞的预测效能。结果观察组TAT水平为(2.87±0.86)ng/mL,高于对照组[(1.86±0.48)ng/mL],PIC水平为(1.15±0.24)μg/mL,低于对照组[(1.61±0.47)μg/mL],TAT/PIC比值为(2.54±0.45)×10^(-3),大于对照组[(1.16±0.23)×10^(-3)],差异均有统计学意义(P<0.05)。有症状组TAT水平为(3.27±0.98)ng/mL,高于无症状组[(2.34±0.59)ng/mL],PIC水平为(0.97±0.15)μg/mL,低于无症状组[(1.40±0.36)μg/mL],TAT/PIC比值为(3.35±0.47)×10^(-3),大于无症状组[(1.67±0.41)×10^(-3)],差异均有统计学意义(P<0.05)。经Pearson相关性分析,老年下肢深静脉血栓患者超声评分、Villalta评分均与TAT、TAT/PIC比值呈正相关(P<0.05),与PIC呈负相关(P<0.05)。经ROC曲线分析,TAT/PIC比值预测老年下肢深静脉血栓患者发生肺栓塞的曲线下面积(AUC)为0.926,大于单一指标TAT和PIC的AUC,差异有统计学意义(P<0.05)。结论凝血-纤溶失衡与老年下肢深静脉血栓严重程度密切相关,其中TAT/PIC比值预测患者发生肺栓塞的效能较好,值得临床予以重视。
Objective To analyze the relationship between coagulation and fibrinolysis imbalance and the severity of deep vein thrombosis of lower extremity in elderly patients and its predictive efficacy for pulmonary embolism.Methods A total of 102 elderly patients with deep vein thrombosis of lower extremity admitted from January 2019 to June 2022 were selected as the observation group,and were subdivided into symptomatic group(45 cases)and asymptomatic group(57 cases)according to whether they had clinical symptoms.Another 102 healthy subjects were selected as control group.Plasma thrombine-antithrombin complex(TAT)and plasminase-α2 plasminase-inhibitor complex(PIC)of all subjects were detected.The TAT/PIC ratio was used as an indicator to evaluate the degree of coagulation-fibrinolytic imbalance.The pathological vessels were evaluated by ultrasonic score and Villalta score to observe the occurrence of pulmonary embolism.The relationship between TAT/PIC ratio,ultrasonic score and Villalta score was analyzed,and its predictive efficacy for pulmonary embolism was analyzed by receiver operating characteristic.Results The TAT level in the observation group was(2.87±0.86)ng/mL,which was higher than that in the control group[(1.86±0.48)ng/mL],the PIC level was(1.15±0.24)μg/mL,which was lower than that in the control group[(1.61±0.47)μg/mL],and the TAT/PIC ratio was(2.54±0.45)×10^(-3),which was greater than that in the control group(1.16±0.23)×10^(-3),the differences were statistically significant(P<0.05).The TAT level of symptomatic group was(3.27±0.98)ng/mL,which was higher than that of asymptomatic group[(2.34±0.59)ng/mL],the PIC level was(0.97±0.15)μg/mL,which was lower than that of asymptomatic group[(1.40±0.36)μg/mL],and the TAT/PIC ratio(3.35±0.47)×10^(-3),which was greater than that of asymptomatic group[(1.67±0.41)×10^(-3)],the differences were statistically significant(P<0.05).By Pearson correlation analysis,the ultrasound score and Villalta score of elderly patients with deep venous thrombosis of lower limbs were positively correlated with TAT and TAT/PIC ratio(P<0.05),and negatively correlated with PIC(P<0.05).According to ROC curve analysis,the area under the curve(AUC)of TAT/PIC ratio predicting pulmonary embolism in elderly patients with deep venous thrombosis of lower limbs was 0.926,which was greater than that of single index TAT and PIC(P<0.05).Conclusion Coagulation-fibrinolytic imbalance is closely related to the severity of lower extremity deep vein thrombosis in elderly patients.TAT/PIC ratio is effective in predicting the occurrence of pulmonary embolism in patients,which is worthy of clinical attention.
作者
代诗琼
张晓蓓
李斌
邱国院
DAI Shi-qiong;ZHANG Xiao-bei;LI Bin(Department of General Practice,Panzhihua Central Hospital,Panzhihua Sichuan 617000,China)
出处
《临床和实验医学杂志》
2023年第16期1743-1747,共5页
Journal of Clinical and Experimental Medicine
基金
四川省卫生健康委员会科研课题(编号:19PJ225)。
关键词
老年
下肢深静脉血栓
严重程度
凝血-纤溶失衡
肺栓塞
Elderly
Lower extremity deep vein thrombosis
Degree of severity
Coagulation-fibrinolytic imbalance
Pulmonary embolism
