摘要
目的:探讨血清P选择素(P-selectin)、白介素-18(IL-18)、同型半胱氨酸(Hcy)预警老年下肢深静脉血栓(DVT)患者介入治疗结局不良的价值。方法:选取2020年1月—2023年8月收治的老年DVT患者165例,均行经导管介入溶栓治疗,根据临床治疗结局分为结局良好组与结局不良组,比较两组血清P-selectin、IL-18、Hcy水平,分析血清P-selectin、IL-18、Hcy与病情指标及介入治疗结局的相关性,评价血清P-selectin、IL-18、Hcy预测介入治疗结局的价值。结果:165例患者经导管介入溶栓治疗总有效率为81.82%(135/165),分别将总有效患者纳入结局良好组,结局不良患者纳入结局不良组。结局不良组患侧-健侧大腿周径差、患侧-健侧小腿周径差大于结局良好组(P<0.05);结局不良组血清P-selectin、IL-18、Hcy水平高于结局良好组(P<0.05);血清P-selectin、IL-18、Hcy水平与患侧-健侧大腿周径差、患侧-健侧小腿周径差呈正相关,与介入治疗结局呈负相关(P<0.05);校正其他因素前后血清P-selectin、IL-18、Hcy均是老年DVT患者介入治疗结局的独立危险因素(P<0.05);血清P-selectin、IL-18、Hcy预测老年DVT介入治疗结局的AUC分别为0.789(95%CI:0.718~0.848)、0.812(95%CI:0.744~0.868)、0.792(95%CI:0.722~0.851),截断值为44.21 ng/mL、185.73 ng/L、23.60μmol/L,敏感度为70.00%、70.00%、80.00%,特异度为82.22%、82.96%、68.15%;三者联合预测老年DVT介入治疗结局的AUC为0.935(95%CI:0.886~0.967),此时三者的截断值为44.08 ng/mL、185.16 ng/L、23.37μmol/L,敏感度为86.67%,特异度为88.15%,明显优于三者单独预测价值(Z=5.817、4.753、5.206,P均<0.001)。结论:血清P-selectin、IL-18、Hcy与老年DVT患者病情指标和介入治疗结局显著相关,能有效预测介入治疗结局,且联合预测价值较高。
Objective:To explore the value of serum P-selectin,Interleukin-18(IL-18),and Homocysteine levels in predicting the adverse outcomes of interventional therapy in elderly patients with deep vein thrombosis(DVT)the lower extremities.Methods:A total of 165 elderly patients with DVT from January 2020 to August 2023 were se-lected.All patients underwent transcatheter intervention thrombolysis therapy.Patients were divided into good outcome group and poor outcome group according to the clinical treatment outcome.Serum P-selectin,IL-18,and Hcy levels were compared between the two groups.The correlation between serum P-selectin,IL-18,and Hcy levels and disease indicators,as well as the outcomes of interventional therapy was analyzed.The predictive value of serum P-selectin,IL-18,and Hcy levels for the outcomes of interventional therapy was evaluated.Results:The total effective rate of catheter-based interventional thrombolysis in 165 patients was 81.82%(135/165).The patients with good outcomes were included in the good outcome group,and the patients with poor outcomes were included in the poor outcome group.The difference in circumference between the affected side and the healthy side of the thigh and the difference in circumference between the affected side and the healthy side of the calf in the poor outcome group were greater than those in the good outcome group(P<0.05).The levels of serum P-selectin,IL-18,and Hcy in the poor outcome group were higher than those in the good outcome group(P<0.05).The levels of serum P-selectin,IL-18,and Hcy were posi-tively correlated with the difference in circumference between the affected and healthy thighs and the difference in cir-cumference between the affected and healthy calves,and negatively correlated with the outcome of interventional therapy(P<0.05).Before and after correcting other factors,serum P-selectin,IL-18,and Hcy were all independent risk factors for the outcome of interventional therapy in elderly patients with DVT(P<0.05).The area under the curve(AUC)of serum P-selectin,IL-18,and Hcy for predicting the outcome of interventional therapy for elderly DVT was 0.789(95%CI:0.718-0.848),0.812(95%CI:0.744-0.868),and 0.792(95%CI:0.722-0.851),respectively.The cutoff values were 44.21 ng/mL,185.73 ng/L,and 23.60μmol/L,with sensitivities of 70.00%,70.00%,and 80.00%,and specificities of 82.22%,82.96%,and 68.15%,respectively.The AUC of the combined prediction of the outcomes of interventional therapy for elderly DVT was 0.935(95%CI:0.886-0.967),with a cutoff value of 44.08 ng/mL,185.16 ng/L,and 23.37μmol/L for the three variables,with a sensitivity of 86.67%and a specificity of 88.15%.This was significantly better than the individual prediction values of the three variables(Z=5.817,4.753,5.206,all P<0.001).Conclusion:Serum P-selectin,IL-18,and Hcy are significantly correlated with disease indicators and interventional treatment outcomes in el-derly patients with DVT,and can effectively predict the outcome of interventional treatment,with a high combined pre-dictive value.
作者
迟洪建
纪艳兵
刘敏
刘启学
CHI Hong-jian;JI Yan-bing;LIU Min;LIU Qi-xue(Department of Vascular Intervention,Qinhuangdao Hospital,Beijing University of Chinese Medicine(Qin-huangdao TCM Hospital),Qinhuangdao 066000,China)
出处
《中国现代普通外科进展》
2025年第3期185-190,共6页
Chinese Journal of Current Advances in General Surgery
基金
河北省重点研发计划项目(22012913011D)。
