| Background:The classical theory of venous thrombosis(VTE): the Virchow triangle,including: blood stasis,hypercoagulable state,vascular injury,which proposed by Rudolf Virchow.In orthopedic patients,blood loss caused by the trauma itself,endothelial injury caused by surgical operation,and passive position during the operation and venous stasis caused by immobility,covering the above three aspects of risk factors,are frequently associated with VTE.Since most venous thrombosis are generally asymptomatic,some of them have acute pulmonary embolism or death as the first symptom.It would be better to use a more sensitive biomarker to evaluate abnormal coagulation early and screen for VTE risk.At present,the diagnosis is based on physical examination and imaging examination,but it is difficult to accurately predict the occurrence and development of venous thrombosis.Therefore,screening biomarkers can provide beneficial help.In the early stage of thrombosis,the blood components adhere to the damaged vascular endothelium,which activates coagulation and fibrinolysis systems,causing fibrin deposition and promoting thrombosis.Thus,intermediates of the three major systems of vascular endothelium,coagulation,and fibrinolysis can be used as markers for early diagnosis of thrombosis.These intermediates include:(1)Thrombin-antithrombin complex(TAT): a marker of thrombin generation;(2)Plasmin inhibitor-plasmin complex(PIC): a marker of plasmin production;(3)Thrombomodulin(TM): a marker of vascular endothelial injury;(4)Tissue plasminogen activator-plasminogen activator inhibitor-1 complex(t PAIC): a marker of determining the extent of repair of the endothelial system.At present,the laboratory indicators for screening venous thrombosis in orthopedic patients are all advanced testing items,such as D-dimer,fibrin degradation products.These indicators are not sensitive to monitor the initiation of coagulation and fibrinolysis systems.Based on the existing testing items,this paper studies the significance of new thrombus markers in traumatic orthopedic patients,and discusses the clinical value of markers in early screening,clinical diagnosis,medication guidance and prognosis evaluation.Objective:1.The study of clinical value of new thrombus markers in diagnosis of thrombotic complications in orthopedic traumatic patients.2.The evaluation of new thrombus markers for anticoagulant therapy guidance in orthopedic traumatic patients.3.The study of new thrombus markers for the prognosis judgement in orthopedic traumatic patients.Methods:1.Subjects: A total of 683 cases of orthopedic traumatic patients were selected as research subjects.Among these patients,630 patients had no thrombosis,and 53 patients developed venous thrombosis.2.Detection methods: The chemiluminescence enzyme immunoassay method was used to detect the plasma level of TAT,PIC,TM,t PAIC;The Sysmex CA7000 was used to detect the level of fibrinogen(FIB),activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT);The immune turbidimetry method was used to detect the plasma level of D-dimer(D-D)and other routine biochemical and blood markers were also quantified.3.Statistical analysis: All statistical analyses were performed with SPSS Statistics for version 20.0 or The R Programming Language for version 3.5.0.Qualitative data were analyzed using the Chi-square test,and quantitative data were analyzed using the Mann-Whitney U test between two groups,and Kruskal-Wallis H test for more than two groups.Associations between individual parameters were calculated using Pearson’s rank correlation tests.ROC curve analysis was performed.All P values were two-sided,P < 0.05 was considered to be statistically significant differences.Results:In orthopedics patients,the levels of PT,APTT,TT,and FIB were observed.After adjusting for covariates,the above indicators were not statistically significant in the venous thrombosis positive and negative groups,which suggested that conventional coagulation indicators were not sensitive to the early diagnosis of thrombosis.Through the detection of new thrombus markers,the following findings were obtained:1.Early diagnosis of venous thrombosis in traumatic orthopedic patients: In the earlystages of thrombosis,TAT markedly elevated.Compared to the venous thrombosis negative group,plasma PIC levels were significantly elevated in the positive group,and this difference persisted after adjusting covariates such as age and sex.The correlation between PIC levels and Caprini scores were statistically significant.ROC analysis showed that PIC had the largest AUC in diagnosing the venous thrombosis in orthopedic patients.2.Guidance for anticoagulant therapy in orthopaedic patients: Dynamic monitoring of the thrombus indicators levels after anticoagulant therapy,found that PIC had the fastest recovery rate after treatment in orthopaedic patients.DCA analysis showed that the net benefit of PIC was the largest.Grouped by age and gender,PIC was still the best indicator to balance the risk-benefit ratio.3.To judge the prognosis of patients with orthopaedics: The plasma of TM and t PAIC levels in orthopaedic patients with non-survivors were significantly higher(P<0.05).After adjusting for the influence of age,gender and other related factors,this difference still exists.Logistic regression analysis showed that the TM and t PAIC were the ideal indicators for evaluating the prognosis of orthopedic patients.The nomogram analysis showed that patients with elevated t PAIC level,the risk of death increased by 20%;with elevated TM level,the risk increased by 10%;with elevated TM and t PAIC levels,the risk increased by up to 50%.The ROC analysis showed that combined two indicators for the prognosis of orthopedic patients was better than that of single index.Conclusion:1.Plasma TAT combined with PIC were superior to DD,Caprini scores in early screening and diagnosis of venous thrombosis complications in orthopaedic trauma patients.2.Dynamic monitoring of plasma PIC levels can be used to guide the use of anticoagulant drugs in orthopaedic trauma patients.3.The combined TM and t PAIC were superior to single index in the prognosis of orthopedic patients... |
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