The Study On The Correlation Between Von Willebrand Factor And Deep Venous Thrombosis

Objective:To evaluate the diagnostic value of von Willebrand factor(VWF)in patients with deep venous thrombosis(DVT)by detecting the expression level of plasma VWF.At the same time,VWF is a sensitive indicator for vascular endothelial injury.At present,there is a clinical concern about whether percutaneous mechanical thrombectomy(PMT)will increase the risk of vascular endothelial injury and post thrombotic syndrome(PTS).To discuss whether AngioJet mechanical thrombectomy will increase vascular endothelial injury compared with catheter directed thrombolysis(CDT)by comparing the dynamic changes of VWF before and after CDT or AngioJet treatment.Materials and methods:1.60 patients with acute lower extremity DVT were selected as the DVT group,all patients were diagnosed by the guideline for the diagnosis and treatment of DVT(third edition).They were divided into 32 patients in the CDT group and 28 patients in the AngioJet group.Thirty healthy adults were selected as the control group.2.60 patients with acute lower extremity DVT underwent CDT or AngioJet mechanical thrombectomy.The peripheral blood samples of 60 patients with DVT were collected before and after treatment and 30 healthy controls were collected during the same period.3.We used the STA Compact automatic coagulation analyzer from the Stago company to detect VWF in plasma by immuno-turbidimetric assay,including 60 patients with acute lower extremity DVT(before and after treatment)and 30 healthy controls.4.General clinical datas such as age,gender,past history,blood routine,biochemical indicators,coagulation parameters,etc.,and the onset time and DVT classification were collected from DVT patients and healthy controls.The difference of thigh circumference between healthy side and ill side(before and after treatment),swelling alleviation,venous patency rate,total urokinase and thrombolysis time were observed and recorded.Results:1.There were no significant differences in gender,age,hypertension and smoking history between the DVT group and the control group(P>0.05).The two groups were comparable.2.The expression level of VWF in the DVT group and in the control group were respectively 163.93±29.25%and 140.67±22.89%.The expression of VWF in the DVT group was significantly higher than that in the control group(P<0.05).Compared with the control group,white blood cell,neutrophil,D-dimer and fibrinogen degradation products were higher in the DVT group,the difference was statistically significant(P<0.05);there were no significant differences in fasting blood glucose,red blood cell,platelet,fibrinogen,antithrombin III between the DVT group and the control group(P>0.05).3.The logistic regression analysis was used to analyze the correlation between acute lower extremity DVT and related clinical indicators.The results showed that there were significant differences in plasma VWF and D-dimer levels between acute lower extremity DVT patients and healthy controls(P<0.05),and increased expression of plasma VWF and D-dimer levels correlates with acute lower extremity DVT.4.According to the plasma VWF expression level of DVT group and control group,the ROC curve was made.The area under the ROC curve(AUC)was 0.817,95%CI(0.729,0.906),which had good diagnostic value(P<0.05).The maximum Youden index was 0.533,the optimal cutoff value of VWF is 157.5%,the sensitivity is 83.3%,the specificity is 70.0%,the positive likelihood ratio is 2.78,the negative likelihood ratio is 0.24,the positive predictive value is 84.7%,and the negative predictive value is 67.7%,the prediction accuracy is 78.9%.The ROC curve of the D-dimer was made by the same method.The area under the curve(AUC)was 0.844,95%CI(0.756,0.933)(P<0.05),and the Youden index was 0.633.The optimal cut-off value of D-dimer is 1.385mg/L,the sensitivity is 76.7%,the specificity is 86.7%,the positive likelihood ratio is 5.77,the negative likelihood ratio is 0.27,the positive predictive value is 92.0%,the negative predictive value is 65.0%and the prediction accuracy is 80.0%.5.There was no significant difference in gender,age,the onset time,DVT classification and the difference of thigh circumference between healthy side and ill side before treatment in the CDT group and the AngioJet group(P>0.05).The difference of thigh circumference between healthy side and ill side after treatment in the AngioJet group was smaller than that in the CDT group.The AngioJet group had higher swelling alleviation and venous patency rate than the CDT group after treatment.The AngioJet group used less urokinase and thrombolysis time than the CDT group,and the difference was statistically significant(P<0.05).The levels of VWF after treatment in the CDT group and the AngioJet group were significantly higher than those before treatment(P<0.05),but there was no significant difference in the levels of VWF after treatment between the CDT group and the AngioJet group(P>0.05).Conclusions:1.Plasma VWF levels are increased in patients with acute lower extremity DVT.2.Increased expression of plasma VWF and D-dimer levels correlates with the acute lower extremity DVT.3.Plasma VWF level has good sensitivity and specificity in predicting acute lower extremity DVT.It has certain clinical application value in DVT diagnose,but the test efficacy is not as high as D-dimer.4.In patients with acute lower extremity DVT,whether choosing CDT or AngioJet treatment,there is no significant difference in the vascular endothelial injury,but AngioJet mechanical thrombectomy can open the deep venous more quickly,reduce the total amount of thrombolytic drugs and the total time of thrombolysis.