Caprini评分和血栓四项等凝血指标预测外科病人的VTE形成

The Caprini Score and Four Thrombosis Coagulation Indicators for Predicting VTE Formation in Surgical Patients

摘要: 目的：探究血浆凝血酶抗凝血酶复合物(TAT)、血栓调节蛋白(TM)、可溶性纤维蛋白单体复合物(PIC)以及组织型纤溶酶原激活剂抑制物复合体(t-PAIC)和其他实验室指标与Caprini评分和静脉血栓栓塞症(VTE)之间的关系，探究VTE的早期诊断的实验室依据，以及Caprini评分和VTE的独立影响因素。方法：收集2023年1月至2024年6月安徽医科大学第二附属医院收治的119例外科住院患者作为研究对象，按照Caprini评分分为低危组(21例)、中危(31例)、高危组(33例)，极高危组(34例)，同时按照实验室检查以及影像学检查诊断是否形成静脉血栓分为血栓组(34例)和无血栓组(85例)，收集患者临床资料，将收集的数据进行Kruskal-Wallis检验、logistic回归、ROC曲线、线性回归、卡方检验、Mann-Whitney U检验和配对样本t检验比较分析。结果：根据Caprini评分将低危、中危患者分为一组，高危、极高危患者一组，两组数据中PIC和TM参数在区分Caprini评分方面要优于其他常见的临床指标；两组数据中TM和D-二聚体是Caprini评分的独立影响因素；根据Caprini评分分为低危组、中危组、高危组、极高危组，四组数据中低危组和中危组的TM值均低于高危组和极高危组(P < 0.05)，极高危组的D-二聚体值均高于低危、中危和高危组(P < 0.05)；同时对患者根据是否形成VTE分为血栓组以及非血栓组，TM和D-二聚体在区分是否有血栓方面要优于其他常见的临床指标，且TM和D-二聚体是VYE独立影响因素；多因素逐布线性回归分析TM和D-二聚体的独立影响因素，TM的独立影响因素只有总胆固醇，D-二聚体的独立影响因素包括：纤维蛋白降解产物(FDP)和白细胞。结论：PIC和TM参数在区分Caprini评分方面要优于其他常见的临床指标；TM和D-二聚体是Caprini评分以及VTE的独立影响因素，随着TM和D-二聚体的数值升高，Caprini评分值以及发生VTE的风险升高。通过进一步分析得出总胆固醇是TM的独立影响因素，FDP和白细胞是D-二聚体的独立影响因素，我们在临床工作中，预防血栓形成要重点关注这些指标。

Abstract: Objective: Investigate the relationships among plasma thrombin antithrombin complex (TAT), thrombomodulin (TM), soluble fibrin monomer complex (PIC), tissue-type plasminogen activator inhibitor complex (t-PAIC) and other laboratory parameters, Caprini score, and venous thromboembolism (VTE), explore the laboratory basis for early diagnosis of VTE, and investigate the independent influencing factors of Caprini score and VTE. Methods: We selected 119 surgical inpatients from Second Affiliated Hospital of Anhui Medical University from January 2023 to June 2024 as the research subjects and divided them into low-risk group (21 cases), moderate-risk group (31 cases), high-risk group (33 cases), and extremely high-risk group (34 cases) according to the Caprini score. We also divided the patients into thrombosis group (34 cases) and non-thrombosis group (85 cases) based on laboratory and imaging examination results. We collected the clinical data of the patients and compared and analyzed the data using Kruskal-Wallis test, logistic regression, ROC curve, linear regression, chi-square test, Mann-Whitney U test, and paired sample t-test. Results: According to the Caprini score, low-risk and intermediate-risk patients were divided into one group, high-risk and extremely high-risk patients into another group. In both groups of data, the PIC and TM parameters were found to be superior in distinguishing the Caprini score from other common clinical indicators. In both groups of data, TM and D-dimer were independent influencing factors of the Caprini score. According to the Caprini score, patients were divided into low-risk group, intermediate-risk group, high-risk group, and extremely high-risk group. In the four groups of data, the TM value was lower in the low-risk and intermediate-risk groups than in the high-risk and extremely high-risk groups (P < 0.05), and the D-dimer value was higher in the extremely high-risk group than in the low-risk, intermediate-risk, and high-risk groups (P < 0.05). At the same time, the patients were divided into thrombosis group and non-thrombosis group based on whether a VTE was formed. TM and D-dimer were found to be superior in distinguishing whether a VTE was formed from other common clinical indicators, and TM and D-dimer were independent influencing factors of VTE. A multivariate stepwise linear regression analysis was conducted to identify the independent influencing factors of TM and D-dimer, and the independent influencing factors of TM were only total cholesterol, while the independent influencing factors of D-dimer included fibrin degradation products (FDP) and white blood cells. Conclusion: The PIC and TM parameters are superior to other common clinical indicators in distinguishing the Caprini score; TM and D-dimer are independent influencing factors of the Caprini score and VTE, and as the values of TM and D-dimer increase, the Caprini score value and the risk of VTE also increase. Through further analysis, we found that total cholesterol is an independent influencing factor of TM, FDP and white blood cells are independent influencing factors of D-dimer. In clinical practice, we should pay attention to these indicators to prevent thrombosis.