Correlations of serum sCD40L, CCL3 with postoperative deep vein thrombosis in patients with multiple rib fractures
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摘要:目的
探讨多发肋骨骨折患者术后血清可溶性CD40配体(sCD40L)、CC趋化因子配体3(CCL3)水平与其术后深静脉血栓(DVT)的关系。
方法选取110例多发肋骨骨折患者作为研究对象, 根据术后是否发生DVT分为非DVT组(n=79)和DVT组(n=31)。采用酶联免疫吸附法测定血清sCD40L、CCL3表达水平; 采用Pearson相关性分析法分析血清sCD40L、CCL3与凝血功能指标的相关性; 采用Logistic回归分析法分析多发肋骨骨折患者术后发生DVT的影响因素; 绘制受试者工作特征(ROC)曲线评估血清sCD40L、CCL3对术后DVT的预测价值。
结果DVT组的血清sCD40L、CCL3表达水平高于非DVT组，差异有统计学意义(P < 0.05)。2组的D-二聚体、凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIB)比较，差异有统计学意义(P < 0.05)。DVT组患者血清sCD40L、CCL3水平与D-二聚体、FIB呈正相关，与PT、TT、APTT呈负相关(P < 0.05)。D-二聚体、PT、APTT、FIB、sCD40L、CCL3是多发肋骨骨折患者术后发生DVT的影响因素(P < 0.05)。血清sCD40L、CCL3单独预测多发肋骨骨折患者术后DVT的曲线下面积(AUC)分别为0.753、0.754，小于两者联合预测的AUC(0.863)，差异有统计学意义(P < 0.05)。
结论多发肋骨骨折患者术后发生DVT与其血清sCD40L、CCL3高水平有关，两者对术后DVT具有一定的预测价值。
Abstract:ObjectiveTo investigate the correlations of postoperative serum levels of soluble CD40 ligand (sCD40L) and CC-chemokine ligand 3 (CCL3) with postoperative deep venous thrombosis (DVT) in patients with multiple rib fractures.
MethodsA total of 110 patients with multiple rib fractures were selected as the study subjects and divided into non-DVT group (n=79) and DVT group (n=31) based on the occurrence of postoperative DVT. Enzyme-linked immunosorbent assay was used to determine the expression levels of serum sCD40L and CCL3. Pearson correlation analysis was employed to analyze the correlations of serum sCD40L, CCL3 with coagulation function indicators. Logistic regression analysis was conducted to identify the influencing factors of postoperative DVT in patients with multiple rib fractures. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of serum sCD40L and CCL3 for postoperative DVT.
ResultsThe expression levels of serum sCD40L and CCL3 in the DVT group were significantly higher than those in the non-DVT group (P < 0.05). There were statistically significant differences in D-dimer, prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT) and fibrinogen (FIB) between the two groups (P < 0.05). In the DVT group, serum levels of sCD40L and CCL3 were positively correlated with D-dimer and FIB, and negatively correlated with PT, TT and APTT (P < 0.05). D-dimer, PT, APTT, FIB, sCD40L and CCL3 were identified as influencing factors for postoperative DVT in patients with multiple rib fractures (P < 0.05). The area under the curve (AUC) of serum sCD40L and CCL3 alone for predicting postoperative DVT in patients with multiple rib fractures was 0.753 and 0.754, respectively, which was significantly smaller than 0.863 of their combined prediction (P < 0.05).
ConclusionPostoperative DVT in patients with multiple rib fractures is associated with high levels of serum sCD40L and CCL3, which have certain predictive value for postoperative DVT.
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表 1 2组术后血清sCD40L、CCL3水平比较(x±s)
pg/mL 组别 n sCD40L CCL3 DVT组 31 329.46±17.05* 18.87±4.51* 非DVT组 79 270.62±12.18 11.53±3.01 sCD40L: 可溶性CD40配体; CCL3: CC趋化因子配体3。与非DVT组比较, * P < 0.05。 
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表 2 多发肋骨骨折患者术后DVT的影响因素分析(x±s)[n(%)]
因素 分类 非DVT组(n=79) DVT组(n=31) χ2/t P 性别 男 42(53.16) 18(58.06) 0.216 0.642 女 37(46.84) 13(41.94) 年龄/岁 45.41±6.58 46.12±6.44 0.512 0.610 BMI/(kg/㎡) 23.05±3.15 22.94±3.08 0.166 0.869 糖尿病史 有 36(45.57) 10(32.26) 1.621 0.203 无 43(54.43) 21(67.74) 高血压史 有 38(48.10) 11(35.48) 1.435 0.231 无 41(51.90) 20(64.52) PT/s 12.78±1.06 11.34±1.01 6.494 < 0.001 TT/s 16.12±1.23 14.53±1.21 6.127 < 0.001 D-二聚体/(ng/mL) 354.19±69.28 1 387.06±129.57 54.051 < 0.001 APTT/s 34.16±4.01 29.86±4.13 5.018 < 0.001 FIB/(g/L) 3.88±0.69 4.93±1.16 5.848 < 0.001 BMI: 体质量指数; PT: 凝血酶原时间; TT: 凝血酶时间; APTT: 部分凝血活酶时间; FIB: 纤维蛋白原。
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表 3 术后发生DVT的患者血清sCD40L、CCL3与各凝血功能指标的相关性分析
指标 sCD40L CCL3 r P r P D-二聚体 0.601 < 0.001 0.436 < 0.001 PT -0.529 < 0.001 -0.507 < 0.001 TT -0.443 < 0.001 -0.426 < 0.001 APTT -0.476 < 0.001 -0.524 < 0.001 FIB 0.611 < 0.001 0.474 < 0.001
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表 4 多发肋骨骨折患者术后DVT的影响因素
因素 B SE Wald χ2 OR 95%CI P D-二聚体 1.681 0.631 7.094 5.369 1.559~18.493 0.008 凝血酶原时间 1.795 0.582 9.515 6.021 1.924~18.840 0.002 部分凝血活酶时间 1.760 0.571 9.504 5.814 1.899~17.804 0.002 凝血酶时间 0.564 0.476 1.405 1.758 0.692~4.469 0.236 纤维蛋白原 1.875 0.539 12.096 6.518 2.266~18.747 0.001 可溶性CD40配体 1.948 0.608 10.264 7.014 2.130~23.094 0.001 CC趋化因子配体3 1.704 0.617 7.626 5.495 1.640~18.415 0.006
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表 5 血清sCD40L、CCL3对DVT的预测价值
指标 最佳截断值 AUC 95%CI 敏感度/% 特异度/% 约登指数 sCD40L 326.07 pg/mL 0.753 0.667~0.835 70.97 83.54 0.545 CCL3 14.66 pg/mL 0.754 0.684~0.848 67.74 83.54 0.513 联合预测 — 0.863 0.785~0.921 93.55 82.28 0.758 sCD40L: 可溶性CD40配体; CCL3: CC趋化因子配体3。
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