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临床输血与检验

临床输血与检验 ›› 2024, Vol. 26 ›› Issue (1): 110-116.DOI: 10.3969/j.issn.1671-2587.2024.01.017

• 临床检验 • 上一篇    下一篇

微小RNA物质、血栓标志物、Wells评分系统联合预测高龄髋部骨折DVT风险价值*

赵亚茹1, 张磊2, 王铭震3   

  1. 1中国人民解放军联勤保障部队第九八〇医院检验科,河北石家庄,050000;
    2中国人民解放军联勤保障部队第九八〇医院急诊医学科,河北石家庄,050000;
    3河北医科大学第四医院检验科,河北石家庄,050000
  • 收稿日期:2023-09-26 发布日期:2024-03-13
  • 作者简介:赵亚茹,主要从事血液病血凝方向研究,（E-mail）cvkm5749@21cn.com。
  • 基金资助:
    *本课题受河北省2023年度医学科学研究课题计划（No.20231312）资助

Combined Use of MicroRNA, Thrombus Markers, and Wells Scoring System for Predicting the Risk of DVT in Elderly Patients with Hip Fracture

ZHAO Yaru1, ZHANG Lei2, WANG Mingzhen3   

  1. 1Department of Clinical Laboratory, 980th Hospital, PLA Joint Logistic Support Force, Shijiazhuang 050000;
    2Department of Emergency Medicine, 980th Hospital, Joint Logistic Support Force, People's Liberation Army, Shijiazhuang 050000;
    3Department of Clinical Laboratory, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050000
  • Received:2023-09-26 Published:2024-03-13

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摘要： 目的 探究微小RNA物质、血栓标志物、下肢深静脉栓塞评分（Wells评分）系统联合对高龄髋部骨折深静脉血栓形成（DVT）风险的预测价值,为减少DVT发生提供诊断依据。方法 选取2020年10月—2022年10月我院收治的105例高龄髋部骨折患者,根据术后1周是否发生DVT分为DVT组（34例）、未DVT组（71例）。比较两组临床资料,于入院后术前进行Wells评分评估,并检测两组微小RNA物质[微小RNA-374b-5p（miR-374b-5p）、微小RNA-664b-3p（miR-664b-3p）]、血栓标志物[凝血酶-抗凝血酶复合物（TAT）、可溶性血栓调节蛋白（sTM）、纤溶酶α2抗纤溶酶复合物（PIC）、组织型纤溶酶原激活物-抑制剂复合物（t-PAIC）],分析DVT发生的影响因素,通过受试者工作特征曲线（ROC）、决策曲线分析（DCA）Wells评分、miR-374b-5p、miR-664b-3p、sTM、PIc、TAT、t-PAIC联合对高龄髋部骨折DVT风险的预测价值及临床效用。结果 DVT组术前血浆FDP水平及Wells评分高度可能占比高于未DVT组（P<0.05）;DVT组miR-374b-5p相对表达量高于未DVT组,miR-664b-3p相对表达量低于未DVT组（P<0.05）;DVT组血浆sTM、PIC、TAT、t-PAIC水平均高于未DVT组（P<0.05）;FDP、Wells评分、miR-374b-5p、miR-664b-3p、sTM、PIC、TAT、t-PAIC均为高龄髋部骨折患者发生DVT的影响因素（P<0.05）;Wells评分、miR-374b-5p、miR-664b-3p、sTM、PIC、TAT、t-PAIC预测高龄髋部骨折DVT风险的AUC值分别为0.666、0.734、0.750、0.730、0.764、0.761、0.800,各指标联合预测高龄髋部骨折患者发生DVT的AUC最大,为0.921,且具有良好临床效用（P<0.05）。结论 miR-374b-5p、miR-664b-3p、sTM、PIC、TAT、t-PAIC、Wells评分系统联合预测高龄髋部骨折DVT风险的预测效能较高,临床效用良好。

关键词: 髋部骨折, 深静脉血栓, Wells评分, miR-374b-5p, miR-664b-3p

Abstract: Objective To discuss the predictive value of microRNA, thrombus markers, and lower extremity deep vein thrombosis scoring system (Wells score) for reflecting the risk of deep vein thrombosis (DVT) in elderly patients with hip fracture to provide diagnostic evidence for reducing the incidence of DVT. Methods A total of 105 elderly patients with hip fracture admitted to our hospital from October 2020 to October 2022 were selected, and divided into DVT group (34 cases) and non-DVT group (71 cases) according to whether DVT occurred one week after surgery. Clinical data between the two groups were compared and Wells score was evaluated before surgery. MicroRNA substances [microRNA-374b-5p (miR-374b-5p), microRNA-664b-3p (miR-664b-3p)], thrombus markers [thrombin-antithrombin complex (TAT), soluble thrombomodulin (sTM), plasmin alpha2-antifibrinolytic complex (PIC), tissue-type plasminogen activator inhibitor complex (t-PAIC)] were detected. The factors influencing the occurrence of DVT were analyzed. The predictive value and clinical utility of Wells score, miR-374b-5p, miR-664b-3p, sTM, PIc, TAT, t-PAIC for predicting the risk of DVT in elderly hip fracture patients by receiver operating characteristic (ROC) curve and decision curve analysis (DCA). Results The plasma FDP level and Wells score in the DVT group before surgery were highly likely to be higher than those in the non-DVT group (P<0.05). The relative expression level of miR-374b-5p in the DVT group was higher than that in the non-DVT group, while the relative expression level of miR-664b-3p was lower (P<0.05). The plasma levels of sTM, PIC, TAT, and t-PAIC in the DVT group were higher than those in the non-DVT group (P<0.05). FDP, Wells score, miR-374b-5p, miR-664b-3p, sTM, PIC, TAT, and t-PAIC were all factors affecting the occurrence of DVT in elderly patients with hip fractures (P<0.05). The AUC values of Wells score, miR-374b-5p, miR-664b-3p, sTM, PIC, TAT, and t-PAIC were 0.666, 0.734, 0.750, 0.730, 0.764, 0.761, and 0.800, respectively. The combined prediction of DVT risk had the highest AUC value of 0.921, with good clinical utility (P<0.05). Conclusion The combination of miR-374b-5p, miR-664b-3p, sTM, PIC, TAT, t-PAIC and Wells score had high predictive efficacy and good clinical utility in predicting the risk of DVT in elderly patients with hip fracture.

Key words: Hip fracture, Deep vein thrombosis, Wells score, MiR-374b-5p, MiR-664b-3p

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