摘要
目的:探讨血清肿瘤坏死因子超家族18(tumor necrosis factor superfamily 18,TNFSF18)、血管性血友病因子裂解蛋白酶(a disintegrin and metalloprotease with a thrombospondin type 1 motif member 13,ADAMTS13)、基质相互作用分子1(stromal interaction molecules 1,STIM1)水平预测全膝关节置换术(total knee arthroplasty,TKA)后下肢深静脉血栓形成(deep venous thrombosis,DVT)的价值。方法:选取2020年3月至2024年3月收治的108例拟择期行单侧TKA的患者,术前空腹抽取静脉血,采用ELISA技术测定血清TNFSF18、ADAMTS13、STIM1水平。根据术后是否发生下肢DVT,将患者分为DVT组和非DVT组。采用Logistic回归分析,分析血清TNFSF18、ADAMTS13、STIM1水平与TKA术后下肢DVT的关系,采用受试者操作特征(receiver operating characteristic,ROC)曲线分析血清TNFSF18、ADAMTS13、STIM1水平预测TKA术后下肢DVT的价值。结果:①分组和一般情况组间对比结果。共纳入108例行TKA的患者,术后36例发生下肢DVT(DVT组)、72例未发生下肢DVT(非DVT组)。2组患者的一般情况(性别、年龄、体质量指数、合并高血压情况、合并糖尿病情况、合并高脂血症情况、手术原因、手术时间、术中输血情况、止血带使用时间、术中失血量)比较,组间差异均无统计学意义。②血清TNFSF18、ADAMTS13、STIM1水平与TKA术后下肢DVT关系的分析结果。DVT组的血清TNFSF18、STIM1水平均高于非DVT组(t=6.886,P=0.000;t=6.863,P=0.000),血清ADAMTS13水平低于非DVT组(t=6.531,P=0.000)。多因素Logistic回归分析结果显示,血清TNFSF18、STIM1水平高,以及ADAMTS13水平低均与TKA术后下肢DVT有关[B=0.804,P=0.001,OR=2.234,95%CI(1.393,3.583);B=0.750,P=0.011,OR=2.117,95%CI(1.185,3.782);B=-1.033,P=0.001,OR=0.356,95%CI(0.194,0.654)]。③血清TNFSF18、ADAMTS13、STIM1水平预测TKA术后下肢DVT价值的分析结果。ROC曲线分析结果显示,血清TNFSF18、ADAMTS13、STIM1水平单独及联合预测TKA术后下肢DVT的ROC曲线下面积分别为0.866、0.889、0.817、0.988,三者联合预测的ROC曲线下面积大于三者单独预测(Z=3.621,P=0.000;Z=3.358,P=0.001;Z=3.442,P=0.001)。结论:血清TNFSF18、ADAMTS13、STIM1水平均能较好地预测TKA术后下肢DVT,而且三者联合预测的效能更好。
Objective:To investigate the value of serum tumor necrosis factor superfamily 18(TNFSF18),a disintegrin and metalloprotease with a thrombospondin type 1 motif member 13(ADAMTS13),and stromal interaction molecules 1(STIM1)levels in predicting lower limb deep venous thrombosis(LDVT)after total knee arthroplasty(TKA).Methods:One hundred and eight patients admitted from March 2020 to March 2024 scheduled for being treated by unilateral TKA were selected and enrolled in the study.The preoperative fasting venous blood samples were collected,and the serum levels of TNFSF18,ADAMTS13,and STIM1 were detected using enzyme-linked immunosorbent assay(ELISA).The included patients were categorized into DVT group and non-DVT group based on the presence or absence of LDVT after TKA.The relationship of serum TNFSF18,ADAMTS13,and STIM1 levels with post-TKA LDVT was examined by logistic regression analysis,and the value of the three biomarkers in predicting post-TKA LDVT was assessed using the receiver operating characteristic(ROC)curve analysis.Results:①Grouping and intergroup comparisons of baseline information.One hundred and eight patients underwent TKA were included in the study.After the TKA,36 patients experienced LDVT(DVT group),while 72 ones did not(non-DVT group).Comparisons of the baseline information,including gender,age,body mass index(BMI),whether combined with hypertension,whether combined with diabetes mellitus,whether combined with hyperlipidemia,causes for surgery,operative time,intraoperative blood transfusion,duration of tourniquet use,and intraoperative blood loss,between the 2 groups revealed no statistically significant differences.②Relationship of serum TNFSF18,ADAMTS13,and STIM1 levels with post-TKA LDVT.The serum levels of TNFSF18 and STIM1 were higher,while that of ADAMTS13 was lower in DVT group compared to non-DVT group(t=6.886,P=0.000;t=6.863,P=0.000;t=6.531,P=0.000).Furthermore,the multi-factor logistic regression analysis revealed that the increased serum TNFSF18 and STIM1 levels,as well as decreased ADAMTS13 level,were associated with LDVT after TKA(B=0.804,P=0.001,OR=2.234,95%CI(1.393,3.583);B=0.750,P=0.011,OR=2.117,95%CI(1.185,3.782);B=-1.033,P=0.001,OR=0.356,95%CI(0.194,0.654)).③The predictive value of serum TNFSF18,ADAMTS13 and STIM1 levels for post-TKA LDVT.The ROC curve analysis revealed that the areas under the curve(AUC)for predicting post-TKA LDVT were 0.866,0.889,0.817,and 0.988 for TNFSF18,ADAMTS13,STIM1,and triple-biomarker combinations,respectively.The AUC of the triple-biomarker combinations in predictive performance was significantly greater than that of any single biomarker alone(Z=3.621,P=0.000;Z=3.358,P=0.001;Z=3.442,P=0.001).Conclusion:Serum TNFSF18,ADAMTS13,and STIM1 levels are the effective predictors for post-TKA LDVT,and the triple-biomarker combinations perform better in predictive performance compared to any single biomarker alone.
作者
邸腾飞
冉昭
朱文明
张懿兰
DI Tengfei;RAN Zhao;ZHU Wenming;ZHANG Yilan(The No.2 Hospital of Baoding,Baoding 071051,Hebei,China)
出处
《中医正骨》
2025年第7期28-32,40,共6页
The Journal of Traditional Chinese Orthopedics and Traumatology
