Hcy、ATⅢ和ACA与下...床预后相关性及对其预测价值_张峰.pdf

Hcy、AT和 ACA 与下肢深静脉血栓形成后综合征患者临床预后相关性及对其预测价值张峰，何兆鹏，刘鹏，张立科基金项目:河北省卫生厅重点科技研究计划(1020140360)作者单位:050000 石家庄，河北医科大学第一医院血管外科作者简介:张峰，本科，主治医师。主要从事血管外科方向研究通讯作者:何兆鹏，E-mail:he860901163 com 摘要 目的探讨同型半胱氨酸(Hcy)、抗凝血酶(AT)和抗心磷脂抗体(ACA)与下肢深静脉血栓形成后综合征(PTS)患者临床预后的相关性及对其预测价值。方法选取2016 年1 月2018 年1 月收治的下肢深静脉 PTS120 例作为观察组，下肢深静脉血栓形成 60 例作为对照组。比较观察组治疗前和对照组及不同预后下肢深静脉 PTS患者治疗前后 Hcy、AT、ACA，分析 Hcy、AT、ACA 对下肢深静脉 PTS 发生风险的影响，探讨 Hcy、AT和 ACA 与下肢深静脉 PTS 患者临床预后相关性，分析 Hcy、AT和 ACA 对下肢深静脉 PTS 患者临床预后预测价值。结果观察组治疗前 Hcy 和 ACA 高于对照组，AT低于对照组(P 0.01)。Hcy、AT和 ACA 高水平下肢深静脉 PTS 发生风险是低水平的 4 652、0 414 和 3 588 倍。治疗后，预后不良下肢深静脉 PTS 患者 Hcy 和 ACA 高于预后良好下肢深静脉PTS 患者，AT低于预后良好下肢深静脉 PTS 患者(P 0.01)。Hcy、AT和 ACA 治疗前后差值绝对值预后不良下肢深静脉 PTS 患者低于预后良好下肢深静脉 PTS 患者(P 0.01)。Hcy、AT和 ACA 治疗前后差值绝对值与下肢深静脉 PTS 患者预后不良独立相关(P 0.01)。Hcy、AT和 ACA 三者联合对下肢深静脉 PTS 患者临床预后预测价值的受试者工作特征曲线下面积高于单一检测(P 0.05，P 0.01)。结论下肢深静脉 PTS 患者 Hcy 和 ACA 升高，AT降低。Hcy、AT、ACA 与下肢深静脉 PTS 发病和临床预后相关，三者联合对下肢深静脉 PTS 患者临床预后的预测价值较高。关键词 血栓形成后综合征;下肢深静脉;同型半胱氨酸;抗凝血酶;抗心磷脂抗体;预后;Logistic 模型;受试者工作特征曲线 中国图书资料分类号 543 文献标志码 A 文章编号 1002-3429(2023)04-0067-06 DOI 10 3969/j issn 1002-3429 2023 04 015Correlation of Hcy，AT and ACA with Clinical Prognosis of Patientswith Post-Thrombotic Syndrome after Deep Vein Thrombosis and TheirPredictive ValueZHANG Feng，HE Zhaopeng，LIU Peng，ZHANG LikeDepartment of Vascular Surgery，the First Hospital of Hebei Medical University，Shijiazhuang 050000，China Abstract ObjectiveTo investigate the correlation of homocysteine(Hcy)，antithrombin (AT)and anticar-diolipin antibody(ACA)with the clinical prognosis of patients with post-thrombotic syndrome(PTS)after deep vein thrombo-sis(DVT)and their predictive value MethodsA total of 120 PTS patients admitted from January 2016 to January 2018were selected as the observation group，and 60 patients with DVT of lower limbs were selected as the control group The levelsof Hcy，AT and ACA before treatment were compared between the observation group and the control group，and the levelswere compared in PTS patients after DVT of lower limbs with different prognoses before and after treatment The effects ofHcy，AT and ACA on the risk of PTS in DVT of lower limbs were analyzed The correlation between Hcy，AT，ACA andthe clinical prognosis of PTS patients after DVT of the lower limbs was explored，and the predictive value of Hcy，AT，andACA for the clinical prognosis of PTS patients after DVT of the lower limbs was analyzed esultsBefore treatment，the Hcyand ACA levels in the observation group were higher than those in the control group，while the AT levels were lower thanthose in the control group(P 0.01)The risk of PTS after DVT of the lower limbs with high levels of Hcy，AT and ACAwas 4 652，0 414 and 3 588 times that of those with low levels After treatment，Hcy and ACA levels in PTS patients afterDVT of the lower limbs with poor prognosis were higher than those in PTS patients after DVT of the lower limbs with good prog-nosis，while AT levels were lower than those in PTS patients with good prognosis(P 0.01)The absolute difference val-76ues of Hcy，AT and ACA before and after treatment were lower in PTS patients after DVT of the lower limbs with poor prog-nosis than in PTS patients after DVT of the lower limbs with good prognosis(P 0.01)The absolute difference values ofHcy，AT and ACA before and after treatment were independently correlated with poor prognosis of PTS patients after DVT ofthe lower limbs(P 0.01)The area under the receiver operating characteristic(OC)curve of Hcy，AT and ACA incombination in predicting clinical prognosis of PTS patients after DVT of lower limbs was higher than that of single detection(P 0.05，P 0.01)ConclusionThe levels of Hcy and ACA were increased and the levels of AT were decreased inpatients with PTS after DVT of lower limbs Hcy，AT and ACA were associated with the incidence and clinical prognosis ofPTS patients after DVT of lower limbs The combined detection of the three was of high predictive value for the clinical progno-sis of PTS patients after DVT of lower limbs Key words Post-thrombotic syndrome;Deep veins of lower limbs;Homocysteine;Antithrombin;Anticardiolipinantibody;Prognosis;Logistic models;eceiver operating characteristic curve下肢深静脉血栓形成后综合征(post-thromboticsyndrome，PTS)是下肢深静脉血栓形成(DVT)的慢性并发症，临床上20%50%的下肢 DVT 患者会发展为下肢深静脉 PTS，表现为下肢水肿、沉重和溃疡，严重影响患者生活工作能力1-3。目前，临床常采用保守和介入等方法治疗下肢深静脉 PTS，但患者远期效果欠佳，故寻找预测下肢深静脉 PTS 远期治疗效果的指标具有重要临床价值。同型半胱氨酸(Hcy)是一种含硫氨基酸，具有细胞毒性。有研究表明 Hcy 是静脉血栓栓塞症的独立危险因素4。抗凝血酶(AT)属于丝氨酸蛋白酶抑制剂超家族，具有抗炎和抗凝作用，其水平降低可引起凝血功能异常，导致血栓形成5。抗心磷脂抗体(ACA)可分泌细胞因子，激活血管内皮细胞，影响凝血系统，促使血栓形成6。结合既往研究分析 Hcy、AT、ACA 可能与血栓形成有关，但其是否可预测下肢深静脉 PTS 患者临床预后现尚未明确。基于此，本研究探讨 Hcy、AT和 ACA 与下肢深静脉 PTS 患者临床预后相关性及对其预测价值，以期为该病临床制订个体化治疗方案提供参考。1资料与方法1.1一般资料选取 2016 年 1 月2018 年 1 月我院收治的下肢深静脉 PTS 120 例作为观察组，下肢 DVT 60 例作为对照组。观察组男 75 例，女 45 例;年龄 38 53(45 26 2 28)岁;体质量指数 21 30(25 32 1.43)kg/m2;病变部位:左侧84 例，右侧36 例;有静脉曲张 48 例，无静脉曲张 72 例。对照组男 36 例，女 24 例;年龄 37 51(44 85 2 03)岁;体质量指数 20 30(24 93 1 39)kg/m2;病变部位:左侧 42例，右侧 18 例;有静脉曲张 24 例，无静脉曲张 36例。2 组性别和年龄等一般资料比较差异无统计学意义(P 0.05)，具有可比性。本研究经医院医学伦理委员会批准执行。1.2纳入与排