膝关节置换术后深静脉血栓栓塞影响因素及血清NETs及sVCAM-1水平变化意义
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陈塍林 CHEN Cheng-lin 西安交通大学医学部附属红会医院关节病医院膝关节病区, 陕西 西安 710054 Knee Department, Joint Hospital, Honghui Hospital Affiliated to the Medical Department of Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China  
惠曙国 HUI Shu-guo 西安交通大学医学部附属红会医院关节病医院膝关节病区, 陕西 西安 710054 Knee Department, Joint Hospital, Honghui Hospital Affiliated to the Medical Department of Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China cgm922363@21cn.com 
王志远 WANG Zhi-yuan 西安交通大学医学部附属红会医院关节病医院膝关节病区, 陕西 西安 710054 Knee Department, Joint Hospital, Honghui Hospital Affiliated to the Medical Department of Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China  
支力强 ZHI Li-qiang 西安交通大学医学部附属红会医院关节病医院膝关节病区, 陕西 西安 710054 Knee Department, Joint Hospital, Honghui Hospital Affiliated to the Medical Department of Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China  
期刊信息:《中国骨伤》2022年,第35卷,第11期,第1053-1059页
DOI:10.12200/j.issn.1003-0034.2022.11.009
基金项目:陕西省自然科学基础研究计划(编号:2019JM2660)
中文摘要:

目的: 探究膝关节置换术后血清中性粒细胞胞外陷阱(neutrophil extracellular traps,NETs)及可溶性血管细胞黏附分子(soluble vascular cell adhesion molecule-1,sVCAM-1)水平变化情况与深静脉血栓栓塞的关系及其影响因素。

方法: 回顾性选取2017年5月至2020年4月30例行膝关节置换术后出现深静脉血栓栓塞患者作为观察组,另自同期住院的膝关节置换术后未出现深静脉血栓栓塞患者中随机抽取60例作为对照组。对比两组临床资料,术前,术后1、3、5 d血清NETs、sVCAM-1水平,采用Logistic多因素回归模型分析膝关节置换术后深静脉血栓栓塞影响因素;采用Pearson相关性分析血清NETs、sVCAM-1水平的关系;绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)得到曲线下面积(areas under the curve,AUC),分析血清NETs、sVCAM-1水平对膝关节置换术后深静脉血栓栓塞的诊断价值。

结果: 两组年龄、体质量指数、术后膝关节抬高屈曲位比例比较,差异有统计学意义(P<0.05)。观察组术后1、3 d血清NETs、sVCAM-1水平均高于对照组(P<0.05)。Logistic回归分析结果显示年龄,体质量指数,术后膝关节抬高屈曲位,术后1、3 d血清NETs、sVCAM-1水平均为膝关节置换术后深静脉血栓栓塞影响因素(P<0.05);Pearson相关性分析可知,膝关节置换术后深静脉血栓栓塞患者术后1、3 d血清NETs、sVCAM-1水平均呈正相关关系(P<0.05);绘制术后1、3 d血清NETs、sVCAM-1水平预测膝关节置换术后深静脉血栓栓塞ROC曲线,结果显示术后1 d血清NETs、sVCAM-1水平AUC均大于术后3 d,具有良好预测效能。

结论: 膝关节置换术后深静脉血栓栓塞影响因素为年龄,体质量指数,术后膝关节抬高屈曲位,术后血清NETs、sVCAM-1水平,尤其是术后血清NETs、sVCAM-1水平变化可作为预测术后深静脉血栓栓塞的潜在生物学标记物,临床需加以重视。
【关键词】关节成形术,置换,膝  静脉血栓栓塞  影响因素  中性粒细胞胞外陷阱  可溶性血管细胞黏附分子
 
Influence factors of deep venous thromboembolism after knee arthroplasty and significance of changes of serum nets and sVCAM-1 levels
ABSTRACT  

Objective: To investigate the relationship between the changes of serum neutrophil extracellular traps (NETs),soluble vascular cell adhesion molecule-1(sVCAM-1) and deep venous thromboembolism after knee arthroplasty.

Methods: From May 2017 to April 2020,30 patients with deep venous thromboembolism after knee arthroplasty were retrospectively selected as the observation group,and 60 patients without deep venous thromboembolism after knee arthroplasty in the same period were randomly selected as the control group. The clinical data,serum levels of nets and sVCAM-1 before and 1,3 and 5 days after operation were compared between the two groups. Logistic regression model was used to analyze the influencing factors of deep venous thromboembolism after knee arthroplasty; Pearson correlation was used to analyze the relationship between serum nets and sVCAM-1 levels;Draw the receiver operating characteristic curve(ROC) to obtain the area under the curve(AUC),and analyze the diagnostic value of serum nets and sVCAM-1 levels for deep vein thromboembolism after knee arthroplasty.

Results: There were statistically significant differences between two groups in age,body mass index,and postoperative knee elevation and flexion ratio(P<0.05). The level of serum NETs and sVCAM-1 on the 1st and 3rd day after surgery of the observation group were higher than the control group(P<0.05). Logistic regression analysis showed that age,body mass index,knee flexion position,serum nets and sVCAM-1 levels at 1 and 3 days after operation were all the influencing factors of DVT after knee arthroplasty (P<0.05);Pearson correlation analysis showed that there was a positive correlation between the levels of serum NETs and sVCAM-1 in patients with deep venous thromboembolism after knee arthroplasty 1 and 3 days after operation(P<0.05). The ROC curve of predicting deep venous thromboembolism after knee arthroplasty by serum nets and sVCAM-1 levels at 1 and 3 days after operation was drawn,the results showed that the AUC of serum nets and sVCAM-1 levels at 1 day after operation was higher than that at 3 days after operation,which had a good predictive effect.

Conclusion: The influencing factors of deep vein thromboembolism after knee arthroplasty are age,body mass index,postoperative knee elevation and flexion,postoperative serum NETs and sVCAM-1 levels,especially postoperative serum NETs and sVCAM-1 levels. Changes can be used as potential biomarkers for predicting postoperative deep vein thromboembolism,and clinical attention should be paid to it.
KEY WORDS  Arthroplasty,replacement,knee  Venous thromboembolism  Influencing factors  Neutrophil extracellular traps,NETs  Soluble vascular cell adhesion molecule-1,sVCAM-1
 
引用本文,请按以下格式著录参考文献:
中文格式:陈塍林,惠曙国,王志远,支力强.膝关节置换术后深静脉血栓栓塞影响因素及血清NETs及sVCAM-1水平变化意义[J].中国骨伤,2022,35(11):1053~1059
英文格式:CHEN Cheng-lin,HUI Shu-guo,WANG Zhi-yuan,ZHI Li-qiang.Influence factors of deep venous thromboembolism after knee arthroplasty and significance of changes of serum nets and sVCAM-1 levels[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(11):1053~1059
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