血管内皮生长因子对老年骨折病人围手术期下肢深静脉血栓的影响
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摘要
目的探讨老年骨折病人围手术期下肢深静脉血栓形成过程中血管内皮生长因子(VEGF)和血栓弹力图的变化趋势和临床价值。方法选取2013年1月至2015年12月芜湖市中医医院老年骨折病人68例,均行手术治疗,根据在围手术期是否发生下肢深静脉血栓分为血栓组29例和非血栓组39例。分别于手术前、手术成功后1、5、10 d等时间点通过ELISA技术进行VEGF、D-二聚体、纤维蛋白原检测,并对全部病人在手术前后行血栓弹力图检测。结果血栓组和非血栓组在手术后血清VEGF测量值血栓组T1、T2、T3、T4值分别为(345. 5±44. 7)、(499. 3±77. 5)、(588. 2±97. 6)、(395. 8±66. 7) pg/m L,非血栓组分别为(363. 1±51. 3)、(441. 6±83. 2)、(493. 5±84. 3)、(364. 3±59. 3) pg/m L,均先升高后降低,术后各时间点血清VEGF测量值比较,血栓组均高于非血栓组(P <0. 05),血栓组病人术后血清VEGF含量上升更为显著,且峰值显著高于非血栓组。同时血栓组在不同时间点的VEGF测量值与相应的D-二聚体和血清纤维蛋白原含量呈强相关的关系(P <0. 05);非血栓组在不同时间点的VEGF测量值与相应的D-二聚体和血清纤维蛋白原含量呈弱相关的关系(P <0. 05)。结论老年骨折病人下肢深静脉血栓的形成过程中VEGF与血清D-二聚体、纤维蛋白原随着时间呈现一定变化规律,这些变化能够反映深部静脉血栓形成过程中血液凝聚状态和纤维蛋白溶解过程的变化,VEGF表达的升高对下肢深部静脉血栓的诊疗过程及其预后转归有一定的指导作用。
Objective To explore the change trend and clinical value of vascular endothelial growth factor( VEGF) and thrombus map of patients with deep venous thrombosis( DVT) in the perioperative period. Methods 68 cases of elderly patients with fracture,were divided into 2 groups( DVT group,non-DVT group) According to whether had DVT perioperativly he serum VEGF,D-dimer and fibrinogen tested atpre and postsurgery. Results The level of VEGF was first rised and then decreased within DVT group( 345. 5 ± 44. 7),( 499. 3 ± 77. 5),( 588. 2 ± 97. 6),( 395. 8 ± 66. 7) pg/m L and non-DVT group( 363. 1 ± 51. 3),( 441. 6 ± 83. 2),( 493. 5 ± 84. 3),( 364. 3 ± 59. 3) pg/m L from T2 to T4 time point( P < 0. 05). There was a strong positive correlation in DVT group between the level of VEGF and D-dimer/fibrinogen from T2 to T4 time point( P < 0. 05). There was a weakly positive correlation in non-DVT group between the level of VEGF and D-dimer/fibrinogen from T2 to T4 time point( P < 0. 05). Conclusion The changes of serum VEGF,Ddimer and fibrinogen in perioperative elderly fracture patients affected with DVT was dynamic correlated with each otherhe expression of VEGF may be more predictive and having prognostic value for acute deep venous thrombosis.
Objective To explore the change trend and clinical value of vascular endothelial growth factor( VEGF) and thrombus map of patients with deep venous thrombosis( DVT) in the perioperative period. Methods 68 cases of elderly patients with fracture,were divided into 2 groups( DVT group,non-DVT group) According to whether had DVT perioperativly he serum VEGF,D-dimer and fibrinogen tested atpre and postsurgery. Results The level of VEGF was first rised and then decreased within DVT group( 345. 5 ± 44. 7),( 499. 3 ± 77. 5),( 588. 2 ± 97. 6),( 395. 8 ± 66. 7) pg/m L and non-DVT group( 363. 1 ± 51. 3),( 441. 6 ± 83. 2),( 493. 5 ± 84. 3),( 364. 3 ± 59. 3) pg/m L from T2 to T4 time point( P < 0. 05). There was a strong positive correlation in DVT group between the level of VEGF and D-dimer/fibrinogen from T2 to T4 time point( P < 0. 05). There was a weakly positive correlation in non-DVT group between the level of VEGF and D-dimer/fibrinogen from T2 to T4 time point( P < 0. 05). Conclusion The changes of serum VEGF,Ddimer and fibrinogen in perioperative elderly fracture patients affected with DVT was dynamic correlated with each otherhe expression of VEGF may be more predictive and having prognostic value for acute deep venous thrombosis.
引文
[1]严广斌.下肢深静脉血栓[J].中华关节外科杂志,2007,1(2):99.
[2] CERVANTES J,ROJAS G. Virchow's legacy:deep vein thrombosis and pulmonary embolism[J]. World Journal of Surgery,2005,29:S30-S34.
[3] KING A. Thrombosis:selective D-dimer testing improves efficiency of DVT diagnosis[J]. Nature reviews. Cardiology,2013,10(3):118.
[4]王晖,余朝文,李博,等.兔急性后腔静脉血栓形成中内皮细胞VEGF与bFGF表达的变化[J].中国普通外科杂志,2013,22(6):726-730.
[5] GELINAS DS,BERNATCHEZ PN,ROLLIN S,et al. Immediate and delayed VEGF‐mediated NO synthesis in endothelial cells:Role of PI3K,PKC and PLC pathways[J]. British Journal of Pharmacology,2002,137(7):1021-1030.
[6] HEIT JA. Epidemiologyof venous thromboembolism[J]. Nature Reviews Cardiology,2015,12(8):464-474.
[7]吴庆华,寇镭.下肢深静脉血栓形成的诊断和治疗[J].中华全科医师杂志,2012,11(2):89-92.
[8]刘建龙,贾伟.骨折后深静脉血栓的早期诊断与处理[J].中华全科医师杂志,2008,7(6):375-377.
[9]赵刚.携带VEGF基因的内皮祖细胞功能改变及在损伤血管内膜修复中的作用[D].重庆:第三军医大学,2007.
[10] WALTHAM M,BURNAND KG,COLLINS M,et al. Vascular endothelial growth factor and basic fibroblast growth factor are found in resolving venous thrombi[J]. Journal of Vascular Surgery,2000,32(5):988-996.
[11] VAN DER ZEE R,MUROHARA T,LUO Z,et al. Vascular endothelial growth factor/vascular permeability factor augments nitric oxide release from quiescent rabbit and human vascular endothelium[J]. Circulation,1997,95(4):1030-1037.
[12] TSURUMI Y,MUROHARA T,KRASINSKI K,et al. Reciprocal relation between VEGF and NO in the regulation of endothelial integrity[J]. Nature Medicine,1997,3(8):879-886.
[13] WHEELER-JONES C,ABU-GHAZALEH R,COSPEDAL R,et al.Vascular endothelial growth factor stimulates prostacyclin production and activation of cytosolic phospholipase A 2 in endothelial cells via p42/p44 mitogen-activated protein kinase[J]. FEBS Letters,1997,420(1):28-32.
[14] ZACHARY I,MATHUR A,YLA-HERTTUALA S,et al. Vascular protection a novel nonangiogenic cardiovascular role for vascular endothelial growth factor[J]. Arteriosclerosis,Thrombosis,and Vascular Biology,2000,20(6):1512-1520.
[15] BAKHSHI H,ALAVI-MOGHADDAM M,WU KC,et al. D-dimer as an applicable test for detection of posttraumatic deep vein thrombosis in lower limb fracture[J]. Am J Orthop(Belle Mead NJ),2012,41(6):E78-E80.
[16] WELLS P S,ANDERSON D R,RODGER M,et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis[J].New England Journal of Medicine,2003,349(13):1227-1235.
[17] GOLDHABER S Z,BOUNAMEAUX H. Pulmonary embolism and deep vein thrombosis[J]. The Lancet,2012,379(9828):1835-1846.
[18] D'ALESSIO A,MARCHETTI M,TARTARI CJ,et al. Long Term Low Molecular Weight Heparin Anticoagulant Therapy Modulates Thrombin Generation and D-dimer in Patients with Cancer and Venous Thromboembolism[J]. Cancer Invest,2017,35(7):490-499.
[19] JORAKU A,NITTA S,TANAKA K,et al. Screening ofdeep vein thrombosis prior to surgery using D-dimer testing and venous ultrasonography of lower extremities[J]. Hinyokika Kiyo,2017,63(6):229-233.
[20] KWIETNIAK M,AL-AMAWI T,BIASZKOWSKI T,et al. The usefulness of D-dimer in diagnosis and prediction of venous thromboembolism in patients with abdominal malignancy[J]. Pol Przegl Chir,2017,89(3):27-30.
[21] TRITSCHLER T,LIMACHER A,MEAN M,et al. Usefulness of DDimer Testing in Predicting Recurrence in Elderly Patients with Unprovoked Venous Thromboembolism[J]. Am J Med,2017,130(10):1221-1224.
[22] INDURUWA I,MOROI M,BONNA A,et al. Platelet collagen receptor GPVI-dimer recognizes fibrinogen and fibrin through their D-domains,contributing to platelet adhesion and activation during thrombus formation[J]. J Thromb Haemost,2018,16(2):389-404.
[2] CERVANTES J,ROJAS G. Virchow's legacy:deep vein thrombosis and pulmonary embolism[J]. World Journal of Surgery,2005,29:S30-S34.
[3] KING A. Thrombosis:selective D-dimer testing improves efficiency of DVT diagnosis[J]. Nature reviews. Cardiology,2013,10(3):118.
[4]王晖,余朝文,李博,等.兔急性后腔静脉血栓形成中内皮细胞VEGF与bFGF表达的变化[J].中国普通外科杂志,2013,22(6):726-730.
[5] GELINAS DS,BERNATCHEZ PN,ROLLIN S,et al. Immediate and delayed VEGF‐mediated NO synthesis in endothelial cells:Role of PI3K,PKC and PLC pathways[J]. British Journal of Pharmacology,2002,137(7):1021-1030.
[6] HEIT JA. Epidemiologyof venous thromboembolism[J]. Nature Reviews Cardiology,2015,12(8):464-474.
[7]吴庆华,寇镭.下肢深静脉血栓形成的诊断和治疗[J].中华全科医师杂志,2012,11(2):89-92.
[8]刘建龙,贾伟.骨折后深静脉血栓的早期诊断与处理[J].中华全科医师杂志,2008,7(6):375-377.
[9]赵刚.携带VEGF基因的内皮祖细胞功能改变及在损伤血管内膜修复中的作用[D].重庆:第三军医大学,2007.
[10] WALTHAM M,BURNAND KG,COLLINS M,et al. Vascular endothelial growth factor and basic fibroblast growth factor are found in resolving venous thrombi[J]. Journal of Vascular Surgery,2000,32(5):988-996.
[11] VAN DER ZEE R,MUROHARA T,LUO Z,et al. Vascular endothelial growth factor/vascular permeability factor augments nitric oxide release from quiescent rabbit and human vascular endothelium[J]. Circulation,1997,95(4):1030-1037.
[12] TSURUMI Y,MUROHARA T,KRASINSKI K,et al. Reciprocal relation between VEGF and NO in the regulation of endothelial integrity[J]. Nature Medicine,1997,3(8):879-886.
[13] WHEELER-JONES C,ABU-GHAZALEH R,COSPEDAL R,et al.Vascular endothelial growth factor stimulates prostacyclin production and activation of cytosolic phospholipase A 2 in endothelial cells via p42/p44 mitogen-activated protein kinase[J]. FEBS Letters,1997,420(1):28-32.
[14] ZACHARY I,MATHUR A,YLA-HERTTUALA S,et al. Vascular protection a novel nonangiogenic cardiovascular role for vascular endothelial growth factor[J]. Arteriosclerosis,Thrombosis,and Vascular Biology,2000,20(6):1512-1520.
[15] BAKHSHI H,ALAVI-MOGHADDAM M,WU KC,et al. D-dimer as an applicable test for detection of posttraumatic deep vein thrombosis in lower limb fracture[J]. Am J Orthop(Belle Mead NJ),2012,41(6):E78-E80.
[16] WELLS P S,ANDERSON D R,RODGER M,et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis[J].New England Journal of Medicine,2003,349(13):1227-1235.
[17] GOLDHABER S Z,BOUNAMEAUX H. Pulmonary embolism and deep vein thrombosis[J]. The Lancet,2012,379(9828):1835-1846.
[18] D'ALESSIO A,MARCHETTI M,TARTARI CJ,et al. Long Term Low Molecular Weight Heparin Anticoagulant Therapy Modulates Thrombin Generation and D-dimer in Patients with Cancer and Venous Thromboembolism[J]. Cancer Invest,2017,35(7):490-499.
[19] JORAKU A,NITTA S,TANAKA K,et al. Screening ofdeep vein thrombosis prior to surgery using D-dimer testing and venous ultrasonography of lower extremities[J]. Hinyokika Kiyo,2017,63(6):229-233.
[20] KWIETNIAK M,AL-AMAWI T,BIASZKOWSKI T,et al. The usefulness of D-dimer in diagnosis and prediction of venous thromboembolism in patients with abdominal malignancy[J]. Pol Przegl Chir,2017,89(3):27-30.
[21] TRITSCHLER T,LIMACHER A,MEAN M,et al. Usefulness of DDimer Testing in Predicting Recurrence in Elderly Patients with Unprovoked Venous Thromboembolism[J]. Am J Med,2017,130(10):1221-1224.
[22] INDURUWA I,MOROI M,BONNA A,et al. Platelet collagen receptor GPVI-dimer recognizes fibrinogen and fibrin through their D-domains,contributing to platelet adhesion and activation during thrombus formation[J]. J Thromb Haemost,2018,16(2):389-404.