Predictive value of D-D, PS, FⅤ and t-PAI-C for pre-thrombotic state and thrombus in puerpera after delivery
-
摘要: 目的 探究D-二聚体(D-D)、蛋白S(PS)、凝血因子(F)Ⅴ、组织纤溶酶原激活物-纤溶酶原激活物抑制剂-1复合物(t-PAI-C)预测产妇分娩后血栓前状态(PTS)及血栓发生的价值。方法 选择2021年9月—2022年8月分娩产妇122例,术后均进行超声检查,根据是否发生PTS,分为阳性组(n=53)及阴性组(n=69),比较2组的D-D、PS、FⅤ、t-PAI-C水平,分析4项指标对PTS的预测价值。根据术后是否发生静脉血栓栓塞(VTE)分为VTE组(n=21)及未发生组(n=101),比较2组D-D、PS、FⅤ、t-PAI-C水平,分析4项指标对VTE诊断价值。结果 阳性组的D-D、FⅤ、t-PAI-C水平均高于阴性组,PS水平低于阴性组,差异有统计学意义(P < 0.05);采用ROC曲线分析,4项指标联合预测产后PTS的AUC为0.985,均高于单一的D-D、PS、FⅤ及t-PAI-C的0.795、0.837、0.815、0.824(P < 0.05);VTE组D-D、FⅤ、t-PAI-C水平均高于非VTE组,PS水平低于非VTE组,差异有统计学意义(P < 0.05);D-D、PS、FⅤ、t-PAI-C联合对VTE诊断的灵敏度、特异度、准确率分别为85.71%、92.08%、90.98%,Kappa值为0.711。结论 D-D、PS、FⅤ、t-PAI-C联合检测有助于预测产后PTS发生,并为VTE诊断提供参考,有助于临床防治PTS及VTE的发生。Abstract: Objective To explore the predictive value of D-dimer(D-D), protein S(PS), coagulation factor(F) V and tissue plasminogen activator plasminogen activator inhibitor-1 complex(t-PAI-C) for pre-thrombotic state(PTS) and thrombus in puerpera after delivery.Methods A total of 122 puerpera undergoing delivery in the hospital were enrolled between September 2021 and August 2022. All underwent ultrasound examination after surgery. According to presence or absence of PTS, they were divided into positive(n=53) and negative group(n=69). The levels of D-D, PS, FⅤ and t-PAI-C were compared between the two groups, and their predictive value for PTS was analyzed. According to presence or absence of postoperative venous thromboembolism(VTE), they were divided into VTE group(n=21) and non-VTE group(n=101), levels of D-D, PS, FⅤ and t-PAI-C were compared between the two groups, and their diagnostic value for VTE was analyzed.Results The levels of D-D, FⅤ and t-PAI-C in positive group were higher than those in negative group, while PS was lower than that in negative group(P < 0.05). ROC curves analysis showed that AUC of D-D combined with PS, FⅤ and t-PAI-C for predicting postpartum PTS was 0.985, greater than that of single index(0.795, 0.837, 0.815, 0.824, P < 0.05). The levels of D-D, FⅤ and t-PAI-C in VTE group were higher than those in non-VTE group, while PS was lower than that in non-VTE group(P < 0.05). The sensitivity, specificity, accuracy and Kappa value of D-D combined with PS, FⅤ and t-PAI-C in the diagnosis of VTE were 85.71%, 92.08%, 90.98% and 0.711, respectively.Conclusion The combined detection of D-D, PS, FⅤ and t-PAI-C may be beneficial to predict postpartum PTS, which can provide reference for VTE diagnosis and be conducive to clinical prevention and treatment of PTS and VTE.
-
表 1 2组一般资料比较
X±S 组别 例数 年龄/岁 产次/次 分娩方式/例 首次下床活动时间/d 阴道分娩 剖宫产 阳性组 53 29.65±5.08 2.03±0.54 28 25 2.91±0.73 阴性组 69 30.13±5.22 1.89±0.51 41 28 2.84±0.77 t 0.509 1.465 0.530 0.509 P 0.612 0.146 0.467 0.612 表 2 2组D-D、PS、FⅤ、t-PAI-C水平比较
X±S 组别 例数 D-D/(μg/L) PS/% FⅤ/% t-PAI-C/(ng/L) 阳性组 53 291.32±21.68 81.14±10.39 124.63±23.15 12.06±2.43 阴性组 69 176.09±17.53 99.25±10.02 98.17±18.59 7.82±1.24 t 32.457 9.738 7.002 12.534 P < 0.001 < 0.001 < 0.001 < 0.001 表 3 D-D、PS、FⅤ、t-PAI-C对产后PTS的预测价值分析
因素 AUC P 截断值 灵敏度/% 特异度/% 95%CI D-D 0.7951) < 0.001 221.93 μg/L 83.02 86.96 0.708~0.882 PS 0.8371) < 0.001 89.64% 81.13 76.81 0.763~0.911 FⅤ 0.8151) < 0.001 111.69% 73.58 82.61 0.737~0.893 t-PAI-C 0.8241) < 0.001 9.23 ng/L 83.02 75.36 0.747~0.901 4项指标联合 0.985 < 0.001 - 96.23 94.20 0.968~1.000 与4项指标联合比较,1)P < 0.05。 表 4 VTE组及非VTE组的D-D、PS、FⅤ、t-PAI-C水平比较
X±S 组别 例数 D-D/(μg/L) PS/% FⅤ/% t-PAI-C/(ng/L) VTE组 21 412.17±48.36 77.69±9.52 153.01±29.18 13.11±2.05 非VTE组 101 188.02±20.14 94.23±11.29 100.65±20.32 8.93±1.36 t 34.644 6.261 9.903 11.641 P < 0.001 < 0.001 < 0.001 < 0.001 表 5 D-D、PS、FⅤ、t-PAI-C对VTE的诊断价值
例 类型 下肢静脉造影 合计 阳性 阴性 4项指标联合 阳性 18 8 26 阴性 3 93 96 合计 21 101 122 -
[1] 吕燕, 桂晓凤. 安胎防漏汤对多囊卵巢综合征伴先兆流产患者血栓前状态的干预作用[J]. 血栓与止血学, 2021, 27(4): 569-570, 573. https://www.cnki.com.cn/Article/CJFDTOTAL-XSZX202104011.htm
[2] 张文娟, 王飞, 苏玉美, 等. 孕妇分娩前后彩超暴风雪征联合凝血状态对产后下肢深静脉血栓发生的预测研究[J]. 中国生育健康杂志, 2019, 30(5): 415-418. https://www.cnki.com.cn/Article/CJFDTOTAL-SYJK201905004.htm
[3] 梁荣丽, 罗宋. 低分子肝素联合小剂量阿司匹林对原因不明复发性流产患者血栓前状态及免疫功能的影响[J]. 中国计划生育学杂志, 2019, 27(2): 50-54. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY201902013.htm
[4] 李可可, 肖扬. 凝血因子Ⅴ与出血和血栓的相关性研究进展[J]. 检验医学, 2022, 37(4): 396-399. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYY202204019.htm
[5] Ito T, Suzuki Y, Sano H, et al. Demonstration of three distinct high-molecular-weight complexes between plasminogen activator inhibitor type 1 and tissue-type plasminogen activator[J]. Thromb Haemost, 2022, 122(3): 336-343. doi: 10.1055/a-1508-7919
[6] 张春荣, 张翠波. 妊娠期高血压疾病患者凝血功能指标的检测及其临床意义[J]. 中国妇幼保健, 2011, 26(3): 472-473. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201103073.htm
[7] 李敏, 金辉, 王友礼, 等. 彩色多普勒超声在患者血栓前状态检查中的价值[J]. 中华医学杂志, 2013, 93(21): 1607-1610. https://www.cnki.com.cn/Article/CJFDTOTAL-LNYX201502011.htm
[8] 何明清, 王娴, 何芳, 等. 彩色多普勒超声联合血液凝血功能检查对孕妇产后血栓前状态诊断及血栓发生预测的价值[J]. 中国综合临床, 2018, 34(3): 272-276.
[9] 姚杰, 杨涛, 郝斌, 等. 妊娠和产褥期静脉血栓栓塞的临床特征及治疗[J]. 中华围产医学杂志, 2020, 23(3): 203-207. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGUD202233011.htm
[10] 姜垚如, 牛蕾蕾, 冯娜, 等. 凝血相关基因多态性与下肢深静脉血栓形成的相关性[J]. 法医学杂志, 2021, 37(2): 145-150, 157. https://www.cnki.com.cn/Article/CJFDTOTAL-FYXZ202102001.htm
[11] 刘平, 邓花娟, 尚莹莹. 剖宫产术后产妇凝血功能和纤溶功能指标水平变化及产后出血危险因素分析[J]. 血栓与止血学, 2020, 26(6): 1016-1018. https://www.cnki.com.cn/Article/CJFDTOTAL-XSZX202006051.htm
[12] 王建睿, 苗伶俐, 孙海潮, 等. TEG及传统凝血检测指标在孕妇血液不同稀释状态下的相关性探讨[J]. 临床血液学杂志, 2021, 34(4): 284-287. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ202104017.htm
[13] 朱玲. 血栓弹力图、凝血功能4项及D-二聚体在不同孕期孕妇凝血功能评估中的临床应用价值[J]. 检验医学与临床, 2021, 18(10): 1424-1426, 1430. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYL202110023.htm
[14] 秦秋燕, 马艳艳. D-D、凝血指标对高龄孕妇产后发生静脉血栓栓塞症的预测价值[J]. 医学临床研究, 2022, 39(6): 949-952.
[15] 朱虹, 曹建民, 冯丽婷, 等. 彩色多普勒超声联合血浆D-二聚体在下肢静脉血栓诊断中的应用[J]. 海南医学, 2020, 31(3): 343-346. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN202003021.htm
[16] 徐杰文. 蛋白S缺乏症合并脑静脉窦血栓形成两例[J]. 新医学, 2020, 51(11): 884-887. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXX202011016.htm
[17] 陈艳, 刘天, 陈璋辉. 静脉血栓栓塞症中遗传性蛋白C和蛋白S缺乏及其遗传危险因素的研究现状[J]. 国际输血及血液学杂志, 2021, 44(3): 191-197.
[18] 张青云, 丁萌, 景阳, 等. 不同溶栓技术治疗急性下肢深静脉血栓形成患者的疗效及对大小腿患健肢周径差血浆D-二聚体蛋白C蛋白S水平的影响[J]. 河北医学, 2021, 27(4): 592-598. https://www.cnki.com.cn/Article/CJFDTOTAL-HCYX202104015.htm
[19] Ichinose A, Osaki T, Souri M. A review of coagulation abnormalities of autoimmune acquired factor V deficiency with a focus on Japan[J]. Semin Thromb Hemost, 2022, 48(2): 206-218.
[20] Duga S, Asselta R, Tenchini ML. Coagulation factor V[J]. Int J Biochem Cell Biol, 2004, 36(8): 1393-1399.
[21] 龙文昕, 李瑞珍, 程春霞, 等. 妊娠合并凝血因子V缺乏1例[J]. 实用妇产科杂志, 2020, 36(9): 720. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202009024.htm
[22] 马玉祥. D-Dimer、AT-Ⅲ、t-PA和PAI-1水平对复发性流产患者血栓前状态的诊断价值[J]. 临床和实验医学杂志, 2016, 15(22): 2226-2228. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLC201622017.htm
[23] 李梅, 唐永钦, 李祥. 血清组织型纤溶酶原激活物-抑制剂复合物水平与冠心病的关联分析[J]. 安徽医药, 2020, 24(1): 54-57. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYY202001014.htm
[24] 汪艳丽, 熊亮, 张静. D-Dimer、AT-Ⅲ、t-PA、PAI-1水平对复发性流产患者血栓前状态的诊断价值[J]. 微循环学杂志, 2016, 26(3): 27-30. https://www.cnki.com.cn/Article/CJFDTOTAL-WXHX201603006.htm