CAJ | 학술논문

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。目的：研究住院患者Caprini血栓風險模型與9項血漿血栓風險標誌物的相關性，評價2種方法診斷靜脈血栓栓塞（venous thromboembolism，VTE）風險的價值。方法採用迴顧性隊列分析研究設計。選擇天津醫科大學總醫院2009—2012年間收治的1066例住院患者，男685例，女381例，年齡19~81歲。採用IL ACL TOP 700型血液凝固儀、Sysmex CA7000血液凝固儀和Vidas熒光免疫分析儀測定待檢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）、遊離蛋白S含量（FPS：Ag）、纖溶酶原激活抑製物活性（PAI：A）、組織型纖溶酶原激活物（t-PA：A）、D-二聚體（D-D）水平。採用受試者工作特徵（receptor operating characteristic，ROC）麯線評價血栓風險標誌物的診斷效能，採用Spearman相關分析血栓標誌物水平與Caprini風險模型的相關性，用Kaplan-Meier麯線進行生存分析。結果 Caprini風險模型5組間的各項血栓風險標誌物水平差異均有統計學意義（D-D、t-PA：A、PAI：A的H值分彆為7.530、3.221和4.974，vWF：Ag、FⅦ：A、FⅧ：A、PC：A、FPS：A、AT：A的F值分彆為6.395、3.887、4.062、2.905、3.218、5.469，P均＜0.01），且與不同分值Caprini風險模型呈顯著相關（D-D、vWF：Ag、FⅦ：A、FⅧ：A、PC：A、FPS：Ag、AT：A、t-PA：A、PAI：A的r分彆為0.805、0.781、0.433、0.509、-0.244、-0.496、-0.263、0.692，P均＜0.01或0.05）。經ROC麯線分析，D-D和vWF：Ag對極高危風險和VTE患者的診斷效能優于其他標誌物（D-D敏感度和特異度分彆為82.1%和53.9%、94.7%和51.7%；vWF：Ag分彆為71.4%和60.9%、81.3%和61.0%）。極高危組（1組與2組）和血漿D-D水平高于臨界值（1024μg/L）的患者在30 d內有更高的VTE纍積風險（Log-rankχ2分彆為65.092和20.785，P均=0.000）。結論9項血栓風險標誌物與Caprini風險分層具有相關性，D-D診斷VTE和Caprini極高危風險的效能優于其他8項指標，血栓標誌物能敏感反映患者隱匿性凝血紊亂，且與Caprini風險模型在臨床應用中具有互補性。
목적：연구주원환자Caprini혈전풍험모형여9항혈장혈전풍험표지물적상관성，평개2충방법진단정맥혈전전새（venous thromboembolism，VTE）풍험적개치。방법채용회고성대렬분석연구설계。선택천진의과대학총의원2009—2012년간수치적1066례주원환자，남685례，녀381례，년령19~81세。채용IL ACL TOP 700형혈액응고의、Sysmex CA7000혈액응고의화Vidas형광면역분석의측정대검자혈관성혈우병인자항원함량（vWF：Ag）、응혈인자Ⅶ활성（FⅦ：A）、응혈인자Ⅷ활성（FⅧ：A）、항응혈매활성（AT：A）、단백C활성（PC：A）、유리단백S함량（FPS：Ag）、섬용매원격활억제물활성（PAI：A）、조직형섬용매원격활물（t-PA：A）、D-이취체（D-D）수평。채용수시자공작특정（receptor operating characteristic，ROC）곡선평개혈전풍험표지물적진단효능，채용Spearman상관분석혈전표지물수평여Caprini풍험모형적상관성，용Kaplan-Meier곡선진행생존분석。결과 Caprini풍험모형5조간적각항혈전풍험표지물수평차이균유통계학의의（D-D、t-PA：A、PAI：A적H치분별위7.530、3.221화4.974，vWF：Ag、FⅦ：A、FⅧ：A、PC：A、FPS：A、AT：A적F치분별위6.395、3.887、4.062、2.905、3.218、5.469，P균＜0.01），차여불동분치Caprini풍험모형정현저상관（D-D、vWF：Ag、FⅦ：A、FⅧ：A、PC：A、FPS：Ag、AT：A、t-PA：A、PAI：A적r분별위0.805、0.781、0.433、0.509、-0.244、-0.496、-0.263、0.692，P균＜0.01혹0.05）。경ROC곡선분석，D-D화vWF：Ag대겁고위풍험화VTE환자적진단효능우우기타표지물（D-D민감도화특이도분별위82.1%화53.9%、94.7%화51.7%；vWF：Ag분별위71.4%화60.9%、81.3%화61.0%）。겁고위조（1조여2조）화혈장D-D수평고우림계치（1024μg/L）적환자재30 d내유경고적VTE루적풍험（Log-rankχ2분별위65.092화20.785，P균=0.000）。결론9항혈전풍험표지물여Caprini풍험분층구유상관성，D-D진단VTE화Caprini겁고위풍험적효능우우기타8항지표，혈전표지물능민감반영환자은닉성응혈문란，차여Caprini풍험모형재림상응용중구유호보성。
ObjectiveTo 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).MethodsOne 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), factorⅦ activity (FⅦ:A), factorⅧ activity (FⅧ: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 coagulationanalyzer, 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.ResultsThere was significant difference with level of thrombosis markers among all Caprini risk stratiifcation groupsH 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, FⅧ: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 efifciency of D-D and vWF:Ag was better than the other markers in extreme high risk and VTE risk (the sensitivity and speciifcity 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-rankχ2 was 65.092 and 20.785 respectively,P=0.000).ConclusionsThere is a strong relationship between the 9 thrombosis markers and the caprini risk stratiifcation. The diagnostic efifciency of D-D is superior to other 8 markers in VTE risk and Caprini extreme high risk. Plasma thrombsis markers could relfect the insidious coagulation disorder, the plasma markers and Caprini model can further increase the diagnostic value in clinical application.