高敏C-反应蛋白、白细胞介素-6、溶血磷脂酸及D-二聚体与下肢骨折后深静脉血栓形成的相关性研究

Correlation of high-sensitivity C-reactive protein, interleukin-6, lysophosphatidic acid and D-dimer with formation of deep venous thrombosis after lower limb fracture

摘要:

目的 分析高敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、溶血磷脂酸(LPA)及D-二聚体(D-Dimer)与下肢骨折后深静脉血栓形成(DVT)的相关性,探讨他们在下肢骨折后DVT中的作用及机制。方法 选取海南西部中心医院收治的下肢骨折患者156例,根据术后是否发生DVT将其分为2组:DVT组(n＝44)和非DVT组(n＝112)。监测患者术前1天、术后第1、3、5天的hs-CRP、IL-6、LPA及D-Dimer水平变化。采用SPSS 19.0统计软件进行统计学分析。应用受试者工作特征(ROC)曲线分析术后各时间点hs-CRP、IL-6、LPA及D-Dimer诊断DVT的价值。Pearson相关分析hs-CRP、IL-6、LPA及D-Dimer的相关性。结果 DVT组术后第1、3、5天的hs-CRP、IL-6、LPA及D-Dimer水平均显著高于非DVT组(P<0.05)。DVT组术后第3、5天的hs-CRP、IL-6、LPA及D-Dimer水平均显著高于第1天(P<0.05),且DVT组术后第5天的hs-CRP、IL-6、LPA及D-Dimer水平显著高于第3天(P<0.05)。非DVT组术后第5天的hs-CRP、IL-6、LPA及D-Dimer水平均显著低于第1天和第3天(P<0.05)。ROC曲线显示,术后第3天4项联合诊断DVT的AUC(95%CI)[0.961(0.896～0.994)]最高,其敏感度和特异度分别为96.8%和90.2%；在单项检测中,术后第3天D-Dimer水平诊断DVT的AUC(95%CI)[0.892(0.833～0.952)]较好,其敏感度和特异度分别为84.6%和87.3%。相关分析显示,DVT患者术后第3天hs-CRP与D-Dimer相关性最好(r=0.826,P<0.001)。结论 hs-CRP、IL-6、LPA及D-Dimer是预测DVT形成的良好指标,术后第3天4项联合诊断DVT的价值较高。

Abstract:

Objective To analyze the correlation of serum levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), lysophosphatidic acid (LPA) and D-dimer with deep venous thrombosis (DVT) after lower limb fracture, and to explore their roles and underlying mechanism in the formation. Methods A total of 156 patients with lower limb fracture admitted in our hospital were enrolled in this study. According to whether DVT occurred after operation, they were divided into DVT group (n=44) and non-DVT group (n=112). The serum levels of hs-CRP, IL-6, LPA and D-dimer were monitored at 1 d before and in 1,3 and 5 d after operation. SPSS statistics 19.0 was used for statistical analysis. The receiver operating characteristic (ROC) curve was used to analyze the values of hs-CRP, IL-6, LPA and D-dimer in the diagnosis of DVT at various time points after operation. Pearson correlation analysis was employed to analyze the correlation among above indicators. Results The serum levels of hs-CRP, IL-6, LPA and D-dimer at 1,3 and 5 d after operation were significantly higher in the DVT group than in the non-DVT group (P<0.05). In the DVT group, the levels of these indicators were notably increased with time elapsing after operation (P<0.05). While in the non-DVT group, the levels on the 5th day were obviously lower than those on the 1st and 3rd days (P<0.05). The ROC curve analysis showed that the area under ROC curve (AUC=0.961,5%CI 0.896-0.994) for DVT diagnosis when the 4 indicators were combined together was the highest on the 3rd day after operation, with sensitivity of 96.8% and specificity of 90.2%. In the test of single indicator, the level of D-dimer on the 3rd day was best for DVT diagnosis with AUC of 0.892(95%CI 0.833-0.952), and sensitivity of 84.6% while specificity of 87.3%. Correlation analysis indicated that the hs-CRP level was well correlated with that of D-dimer on the 3rd day after operation in the DVT patients (r=0.826, P<0.001). Conclusion hs-CRP, IL-6, LPA and D-dimer are good indicators to predict the formation of DVT, and the value of combined diagnosis of DVT is quite higher on the 3rd day after operation.