血栓分子标志物联合Caprini评分对重度颅脑损伤患者急诊术后DVT形成的风险预测

Predicting Value of the Thrombosis Molecular Markers Combined with Caprini Assessment for the Risk of DVT Formation after Emergency Surgery in Patients with Severe Craniocerebral Injury

摘要: 目的：分析重度颅脑损伤患者急诊术后DVT形成的危险因素及血栓分子标志物联合Caprini评分对DVT形成的预测价值。方法：回顾性分析2023年01月至2024年08月就诊于安徽医科大学第二附属医院的116例患者的病历资料。根据入住ICU后的下肢血管超声结果分为病例组(n = 32)与对照组(n = 84)，比较两组临床资料、D-D二聚体(D-D)、纤维蛋白原分解产物(FDPs)、血栓分子标志物水平[凝血酶–抗凝血酶III复合物(TAT)、纤溶酶-α2-纤溶酶抑制剂复合物(PIC)、血栓调节蛋白(TM)、组织型纤溶酶原激活物–抑制剂复合物(t-PAIC)]、Caprini评分及Caprini分级，采用单因素和多因素logistic回归分析重度颅脑损伤患者急诊术后下DVT形成的危险因素，通过绘制受试者工作特征(ROC)曲线分析TAT、TM、PIC、t-PAIC及四项指标联合Caprini评分对重度颅脑损伤患者急诊术后DVT形成的预测价值。结果：两组吸烟史、手术时长、术中输血史、FDPs、D-D二聚体、TAT、PIC、t-PAIC、Caprini评分及Caprini分级比较，组间差异有统计学意义(P < 0.05)；多因素显示D-D二聚体、FDPs、TAT、TM、PIC、t-PAIC、Caprini评分、Caprini分级是重度颅脑损伤急诊术后DVT的独立危险因素(P < 0.05)；ROC曲线显示，TM、TAT、PIC、t-PAIC、血栓分子标志物联合、血栓分子标志物联合Caprini评分预测ROC曲线下面积(AUC)分别为0.753、0.773、0.802、0.812、0.897、0.927。结论：血栓分子标志物(TM, TAT, PIC, t-PAIC)水平、Caprini评分及Caprini分级是影响重度颅脑损伤急诊术后患者DVT形成的独立危险因素，血栓分子标志物四项联合Caprini评分能早期预测重度颅脑损伤患者急诊术后DVT的发生。

Abstract: Objective: To analyze the risk factors for deep vein thrombosis in patients with severe craniocerebral injury after emergency surgery and the predictive value of thrombotic molecular markers combined with Caprini assessment on DVT formation in patients with severe craniocerebral injury. Methods: We retrospectively analyzed the clinical record of 116 patients who were admitted to the second hospital of Anhui Medical University from January 2023 to August 2024. According to the results of ultrasound of lower limb blood vessels after admission to the ICU, the patients were divided into a case group (n = 32) and a control group (n=84). The medical records, the level of D-D dimers (D-D), fibrinogen breakdown products (FDPs), thrombosis molecular markers [thrombin-antithrombin III complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), thrombomodulin (TM), and tissue-type plasminogen activator-inhibitor complex (t-PAIC)], Caprini score and Carprini grade were compared between the two groups. Univariate and multivariate logistic regression analysis was used to analyze the risk factors for DVT formation after emergency surgery in patients with severe craniocerebral injury. The receiver operating characteristic curve (ROC) was drawn to analyze the predictive value of TAT, TM, PIC, t-PAIC and the four indicators combined with Caprini score in DVT formation after emergency surgery in patients with severe craniocerebral injury. Results: There were significant differences in smoking history, operation time, intraoperative blood transfusion history, FDPs, D-D dimer, TAT, PIC, t-PAIC, Caprini score and Caprini grade between the two groups (P < 0.05). Multivariate analysis showed that D-D dimer, TAT, TM, PIC, t-PAIC, Caprini score and Caprini grade were independent risk factors for DVT formation after emergency surgery in patients with severe craniocerebral injury (P < 0.05). ROC curves respectively showed that the areas under the ROC curves (AUC) of TM, TAT, PIC, t-PAIC, combined thrombotic molecular markers and combined thrombotic molecular markers with Caprini score were 0.753, 0.773, 0.802, 0.812, 0.897 and 0.927. Conclusion: The levels of thrombotic molecular markers (t-PAIC, TAT, PIC, TM) and Caprini score are independent risk factors for DVT formation after emergency surgery in patients with severe craniocerebral injury. The four thrombotic molecular markers combined with Caprini score can early predict the occurrence of DVT formation after emergency surgery in patients with severe craniocerebral injury.