摘要
目的观察断指再植患者术后血清丙二醛(MDA)、超氧化物歧化酶(SOD)、血管内皮生长因子(VEGF)水平变化,明确其与患者发生动脉血管危象的关系,进一步了解其预测动脉危象是否发生的效能。方法选择断指再植术后早期发生动脉血管危象患者(观察组)及未发生血管危象患者(对照组),通过比较两组不同时间(术前、术后24 h水平、动脉血管危象确诊时)MDA、SOD、VEGF水平,Spearman相关性及多因素Logistic回归分析等方法探讨血清MDA、SOD、VEGF水平与术后动脉血管危象的相关性,ROC评估断指再植术后24 h血清MDA、SOD、VEGF水平对术后动脉血管危象的预测效能,并通过对比不同MDA、SOD、VEGF水平患者发生动脉血管危象的风险再次验证血清MDA、SOD、VEGF水平与断指再植术后并发动脉血管危象风险的关系。结果与术前比较,两组术后24 h、动脉血管危象确诊时MDA、VEGF水平均升高,SOD水平均降低(P均<0.05);与术后24 h比较,两组动脉血管危象确诊时MDA、VEGF水平降低,SOD水平升高(P均<0.05);与对照组比较,观察组术后24 h MDA水平高,SOD、VEGF水平低(P均<0.05)。Spearman相关性分析显示,术后24 h、动脉血管危象确诊时,血清MDA水平均与断指再植术后动脉血管危象呈正相关(r分别为0.859、0.954,P均<0.05);血清SOD、VEGF水平与断指再植术后动脉血管危象呈负相关(r分别为-0.826、-0.915、-0.801、-0.887,P均<0.05),且术后24 h血清MDA、SOD、VEGF水平为断指再植术后动脉血管危象发生的独立影响因素(P均<0.05)。术后24 h,MDA、SOD、VEGF预测动脉血管危象的最佳诊断界值分别为8.21 nmol/mL、64.35 nmol/mL、126.37 pg/mL,AUC分别为0.776、0.794、0.714,95%CI分别为0.691~0.847、0.711~0.863、0.625~0.793,敏感度分别为72.50%、85.00%、57.50%,特异度分别为76.25%、70.00%、76.25%。MDA高水平(MDA≥8.21 nmol/mL)患者发生动脉血管危象的危险度是低水平(MDA<8.21 nmol/mL)患者的6.795倍,SOD高水平(SOD≥64.35 nmol/mL)患者发生动脉血管危象的危险度是低水平(SOD<64.35 nmol/mL)患者0.065的倍,VEGF高水平(VEGF≥126.37 pg/mL)患者发生动脉血管危象的危险度是低水平(VEGF<126.37pg/mL)患者的0.189倍(P<0.05)。结论断指再植术后血清MDA、SOD、VEGF水平与患者发生动脉血管危象有关,术后24 h血清MDA、SOD、VEGF检测可预测断指再植术后是否发生动脉血管危象。
Objective To observe the changes of serum malondialdehyde(MDA),superoxide dismutase(SOD)and vascular endothelial growth factor(VEGF)levels after replantation of severed finger,to clarify their relationships with the occurrence of arterial crisis in patients,and to further understand its effectiveness in predicting the occurrence of arteri⁃al crises.Methods Patients with early arterial crisis after replantation of severed finger(observation group)and patients without vascular crisis(control group)were selected.The levels of MDA,SOD and VEGF were compared between the two groups at different time(before surgery,24 h after surgery,and when the arterial crisis was confirmed).Spearman correla⁃tion and multiple Logistic regression analysis were used to explore the correlations between serum MDA,SOD and VEGF levels and postoperative arterial crisis,and to evaluate the diagnostic efficacy of MDA,SOD and VEGF on postoperative arterial crisis at 24 h after replantation of severed finger.The relationships between serum levels of MDA,SOD and VEGF and the risk of arterial crisis after finger replantation was verified again by comparing the risk of arterial crisis in patients with different levels of MDA,SOD and VEGF.Results Compared with pre-operation,MDA and VEGF increased and SOD decreased in both groups at 24 h after operation and at the time of diagnosis of arterial crisis(all P<0.05).Compared with 24 h after operation,MDA and VEGF decreased and SOD increased in both groups at the time of diagnosis of arterial crisis(all P<0.05).Compared with the control group,the MDA was higher and the SOD and VEGF were lower in the ob⁃servation group at 24 h after operation(all P<0.05).Spearman correlation analysis showed that serum MDA was positively correlated with arterial crisis after replantation of severed finger at 24 h after operation and at the time of diagnosis of arteri⁃al crisis(r=0.859,0.954,all P<0.05);at 24 h after operation and at the time of diagnosis of arterial crisis,serum SOD and VEGF were negatively correlated with arterial crisis after replantation of severed finger(r=-0.826,-0.915,-0.801,-0.887,all P<0.05),and serum MDA,SOD and VEGF at 24 h after operation were independent influencing factors of ar⁃terial crisis after replantation of severed finger(all P<0.05).At 24 h after operation,the best diagnostic thresholds of MDA,SOD and VEGF in predicting arterial crisis were 8.21,64.35 and 126.37 pg/mL,respectively,AUC was 0.776,0.794 and 0.714,respectively,95%CI was 0.691-0.847,0.711-0.863,and 0.625-0.793 respectively,their sen⁃sitivities were 72.50%,85.00%and 57.50%,and specificities were 76.25%,70.00%and 76.25%,respectively.The risk of arterial crisis in patients with high level of MDA(MDA≥8.21 nmol/mL)was 6.795 times that of patients with low level(MDA<8.21 nmol/mL),the risk of arterial crisis in patients with high level of SOD(SOD≥64.35 nmol/mL)was 0.065 times that of patients with low level(SOD<64.35 nmol/mL),and the risk of arterial crisis in patients with high lev⁃el of VEGF(VEGF≥126.37 pg/mL)was 0.189 times that of patients with low level(VEGF<126.37 pg/mL)(all P<0.05).Conclusion The serum levels of MDA,SOD and VEGF after replantation of severed finger are related to the oc⁃currence of arterial crisis,and the detection of MDA,SOD and VEGF at 24 h after the operation can predict the occur⁃rence of arterial crisis after replantation of severed finger.
作者
石宇
郑文
赵玲珑
滕云升
SHI Yu;ZHENG Wen;ZHAO Linglong;TENG Yunsheng(Orthopedics Department,Xi'an Ordnance Industry No.521 Hospital,Xi'an 710065,China)
出处
《山东医药》
CAS
2023年第15期11-15,共5页
Shandong Medical Journal
关键词
丙二醛
超氧化物歧化酶
血管内皮生长因子
断指再植术并发症
血管危象
动脉血管危象
动脉栓塞
动脉痉挛
断指再植术
malonaldehyde
superoxide dismutase
vascular endothelial growth factor
complications of replanta⁃tion of severed fingers
vascular crisis
arterial vascular crisis
arterial embolism
arterial spasm
replantation of sev⁃ered fingers
