血清标志物预测全膝关节置换下肢静脉血栓△

Serum markers predicting deep vain thrombosis of the lower extremity after total knee arthroplasty

摘要:

[目的] 评价血清巨噬细胞炎性蛋白 1α （macrophage inflammatory protein-1α, MIP-1α） 和皮质醇 （cortisol, Cor） 预测骨关节炎患者全膝关节置换术 （total knee arthroplasty, TKA） 后继发深静脉血栓 （deep vain thrombosis, DVT） 的价值。[方法] 2019 年 6 月—2023 年 6 月于本院行 TKA 的骨关节炎患者 231 例纳入本研究。依据术后超声检查，将患者分为 DVT 组和非 DVT 组。采用单项因素比较和逻辑回归分析 DVT 发生的相关因素。采用受试者工作特征曲线（receiver operating characteris- tic curve, ROC） 分析血清 MIP-1α、Cor 单独及联合预测 TKA 后 DVT 的效能。[结果] 231 例患者中 53 例确诊为 DVT，占 22.9%。DVT 组的 BMI [(24.0±2.1) kg/m2 vs (23.3±2.0) kg/m2 , P=0.037]、糖尿病比率 [是/否, (10/43) vs (14/164), P=0.021]、全身麻醉比率 [全麻/腰麻, (38/15) vs (92/86), P=0.010]、MIP-1α [(19.7±5.3) pg/mL vs (14.2±5.2) pg/mL, P＜0.001] 和 Cor 的水平 [(305.7±51.5) nmol/L vs (255.3±44.8) nmol/L, P＜0.001] 显著高于非 DVT 组。回归分析显示，BMI （OR=1.818, 95% CI: 1.217~2.718）、糖尿病 （OR=1.980, 95% CI: 1.201~3.263）、全身麻醉（OR=1.857, 95% CI: 1.336~2.581）、MIP-1α（OR=2.042, 95% CI: 1.498~2.783）、Cor（OR=1.876, 95% CI: 1.264~2.781）是术后 DVT 的危险因素。ROC 曲线显示，血清 MIP-1α、Cor 联合预测术后 DVT 的灵敏度及曲线下面积 （area under curve, AUC） 分别为 0.767、0.778、0.838。[结论] 术前血清 MIP-1α、Cor 升高是骨关节炎 TKA 后 DVT 的危险因素，两者联合检测对其发生具有较高的预测效能。

Abstract:

[Objective] To evaluate predicting value of macrophage inflammatory protein-1α (MIP-1α) and cortisol (Cor) for deep vain thrombosis (DVT) after total knee arthroplasty (TKA) for osteoarthritis. [Methods] A total of 231 patients who underwent TKA for osteoarthritis in our hospital from June 2019 to June 2023 were included in this study. According to whether DVT noted by postoperative ultrasonography, the patients were divided into DVT group and non-DVT group. The univariate comparison and logistic regression were conducted to research the related factor. In addition, the efficacy of serum MIP-1α and Cor alone, or in combination to predict DVT after TKA was analyzed by receiver operating characteristic curve (ROC). [Results] Among 231 patients, 53 (22.9%) were diagnosed with DVT. The DVT group proved significantly greater than the non-DVT group in terms of BMI [(24.0±2.1) kg/m2 vs (23.3±2.0) kg/m2 , P=0.037], diabetes rates [y/n, (10/43) vs (14/164), P=0.021], general anesthesia ratio [general anesthesia/lumbar anesthesia, (38/15) vs (92/86), P=0.010], MIP-1 alpha [(19.7±5.3) pg/mL vs (14.2±5.2) pg/mL, P＜0.001] and Cor [(305.7±51.5) nmol/L vs (255.3±44.8) nmol/L, P＜0.001]. As consequence of regression analysis, the BMI (OR=1.818, 95% CI: 1.217~2.718), diabetes (OR=1.980, 95% CI: 1.201~3.263), general anesthesia (OR=1.857, 95% CI: 1.336~2.581, MIP-1α (OR=2.042, 95% CI: 1.498-2.783), Cor (OR=1.876, 95% CI: 1.264~2.781) were the risk factors for postoperative DVT. ROC curve showed that the area under curve (AUC) of serum MIP-1α, Cor and a combination of them in predicting postoperative DVT were of 0.767, 0.778 and 0.838, respectively. [Conclusion] Elevated serum MIP-1α and Cor before operation are risk factors for DVT after TKA for osteoarthritis, and the combined detection of MIP-1α and COR has high predictive efficacy for the occurrence of DVT.