【摘要】 目的研究住院患者Caprini血栓风险模型与9项血浆血栓风险标志物的相关性,评价2种方法诊断静脉血栓栓塞(venous thromboembolism,VTE)风险的价值。方法采用回顾性队列分析研究设计。选择天津医科大学总医院2009—2012年间收治的1066例住院患者,男685例,女381例,年龄19~81岁。采用IL ACL TOP 700型血液凝固仪、Sysmex CA7000血液凝固仪和Vidas荧光免疫分析仪测定待检者血管性血友病因子抗原含量(vWF:Ag)、凝血因子Ⅶ活性(FⅦ:A)、凝血因子Ⅷ活性(FⅧ:A)、抗凝血酶活性(AT:A)、蛋白C活性(PC:A)、游离蛋白S含量(FPS:Ag)、纤溶酶原激活抑制物活性(PAI:A)、组织型纤溶酶原激活物(t-PA:A)、D-二聚体(D-D)水平。采用受试者工作特征(receptor operating characteristic,ROC)曲线评价血栓风险标志物的诊断效能,采用Spearman相关分析血栓标志物水平与Caprini风险模型的相关性,用Kaplan-Meier曲线进行生存分析。结果 Caprini风险模型5组间的各项血栓风险标志物水平差异均有统计学意义(D-D、t-PA:A、PAI:A的H值分别为7.530、3.221和4.974,vWF:Ag、FⅦ:A、FⅧ:A、PC:A、FPS:A、AT:A的F值分别为6.395、3.887、4.062、2.905、3.218、5.469,P均<0.01),且与不同分值Caprini风险模型呈显著相关(D-D、vWF:Ag、FⅦ:A、FⅧ:A、PC:A、FPS:Ag、AT:A、t-PA:A、PAI:A的r分别为0.805、0.781、0.433、0.509、-0.244、-0.496、-0.263、0.692,P均<0.01或0.05)。经ROC曲线分析,D-D和vWF:Ag对极高危风险和VTE患者的诊断效能优于其他标志物(D-D敏感度和特异度分别为82.1%和53.9%、94.7%和51.7%;vWF:Ag分别为71.4%和60.9%、81.3%和61.0%)。极高危组(1组与2组)和血浆D-D水平高于临界值(1024μg/L)的患者在30 d内有更高的VTE累积风险(Log-rankχ2分别为65.092和20.785,P均=0.000)。结论 9项血栓风险标志物与Caprini风险分层具有相关性,D-D诊断VTE和Caprini极高危风险的效能优于其他8项指标,血栓标志物能敏感反映患者隐匿性凝血紊乱,且与Caprini风险模型在临床应用中具有互补性。更多还原

【Abstract】 Objective To study on the relativity between the Caprini thrombosis risk score and nine plasma thrombosis markers in hospitalized patients and to estimate the value of these methods in the risk assessment of venous thromboembolism(VTE). Methods One thousand and sixty-six hospitalized patients were selected from the Tianjin Medical University General Hospital from the 2009 to 2012 for retrospective cohort study, including 685 males and 381 females whose, age were 19-81 years. The level of von Willebrand factor antigen(vWF:Ag), factor Ⅶ activity(F Ⅶ :A), factor Ⅷ activity(F Ⅷ :A), antithrombin activity(AT:A), protein C activity(PC:A), free protein S antigen(FPS:Ag), plasminogen activator inhibitor activity(PAI:A), tissue plasminogen activator activity(t-PA:A) and D-dimer(D-D) were determined with IL ACL TOP 700 coagulation analyzer, Sysmex CA7000 coagulation analyzer and the Biomerieux Vidas fluor-euzymelinked immunoassay analyzer assay. The receiver operating characteristic curve(ROC) to analyze the diagnosis performance of the biomarkers were calulated. The correlation between the level of markers and the Caprini score in patients was assessed using Spearman correlation analysis. Kaplan-Meier curve analysis was peformed to determine the survival aralysis. Results There was significant difference with level of thrombosis markers among all Caprini risk stratifi cation groups H value of(D-D, t-PA:A and PAI:A was 7.530, 3.221, 4.974, respectively; F value of vWF:Ag, FⅦ:A, F Ⅷ :A, PC:A, FPS:A, AT:A was 6.395, 3.887, 4.062, 2.905, 3.218, 5.469, respectively, P < 0.01). There was positive correlation between the plasma thrombosis markers and Caprini score(r value was D-D 0.805, vWF:Ag 0.781, FⅦ:A 0.433, FⅧ:A 0.509, FPS:Ag-0.244, AT:A-0.496, t-PA:A-0.263, PAI:A 0.692,respectively, P<0.01 or 0.05). The ROC analysis indicated the diagnostic effi ciency of D-D and vWF:Ag was better than the other markers in extreme high risk and VTE risk(the sensitivity and specifi city of D-D was 82.1% and 53.9%, 94.7% and 51.7%, respectively; vWF:Ag was 71.4% and 60.9%, 81.3% and 61.0%, respectively). There was higher cumulative risk of VTE within 30 d for patients with extreme high risk group and D-D level exceeded the cut-off(1024 μg/L) group(Log-rank χ2 was 65.092 and 20.785 respectively, P=0.000). Conclusions There is a strong relationship between the 9 thrombosis markers and the caprini risk stratifi cation. The diagnostic effi ciency of D-D is superior to other 8 markers in VTE risk and Caprini extreme high risk. Plasma thrombsis markers could refl ect the insidious coagulation disorder, the plasma markers and Caprini model can further increase the diagnostic value in clinical application.更多还原