vWF抗原和活性联合检测对恶性肿瘤患者静脉血栓事件的预测价值

doi:10.3760/cma.j.issn.1007-1245.2023.22.023

国际医药卫生导报 ›› 2023, Vol. 29 ›› Issue (22): 3240-3244.DOI: 10.3760/cma.j.issn.1007-1245.2023.22.023

vWF抗原和活性联合检测对恶性肿瘤患者静脉血栓事件的预测价值

闫彬¹ 杜伟鹏¹ 翟素平¹ 胡天喜¹ 陶林静¹ 叶亚平¹ 周媛¹ 孙星²

¹南阳市中心医院医学检验科，南阳　473000；²南阳市中心医院肿瘤内科，南阳　473000

收稿日期:2023-06-09 出版日期:2023-11-15 发布日期:2023-11-23
通讯作者: 杜伟鹏，Email：duwp1974@163.com
基金资助:
河南省与国家卫健委省部共建青年项目（SBGJ202103109）；河南省重点研发与推广专项科技攻关项目（212102310805）；南阳市重点研发与推广专项科技攻关项目（KJGG094）

Value of combined detection of vWF antigen and activity in prediction of venous thromboembolic events in patients with cancers

Yan Bin¹, Du Weipeng¹, Zhai Suping¹, Hu Tianxi¹, Tao Linjing¹, Ye Yaping¹, Zhou Yuan¹, Sun Xing²

¹Department of Clinical Laboratory Medicine, Nanyang Central Hospital, Nanyang 473000, China; ²Department of Medical Oncology, Nanyang Central Hospital, Nanyang 473000, China

Received:2023-06-09 Online:2023-11-15 Published:2023-11-23
Contact: Du Weipeng, Email: duwp1974@163.com
Supported by:
Provincial Co-construction Youth Project of Henan and National Health Commission (SBGJ202103109); Problem-tackling Scientific and Technological Project of Key Research and Special Generalized Program in Henan (212102310805); Problem-tackling Scientific and Technological Project of Key Research and Special Generalized Program in Nanyang (KJGG094)

摘要/Abstract

摘要：

目的　探讨恶性肿瘤患者血管性血友病因子（von Willebrand factor antigen，vWF）的抗原（vWF antigen，vWF：Ag）、活性（vWF activity，vWF：Ac）水平预测恶性肿瘤患者发生静脉血栓栓塞（venous thromboembolism，VTE）事件的临床价值。方法　选取2020年6月至2021年12月在南阳市中心医院就诊的恶性肿瘤患者167例作为恶性肿瘤组，其中男97例，女70例，年龄（52.53±10.58）岁；选取同期体检正常、与恶性肿瘤组相匹配的135例志愿者作为健康对照组，其中男91例，女44例，年龄（47.56±8.09）岁。检测两组vWF：Ag和vWF：Ac水平。采用非参数Mann-Whitney U检验分析恶性肿瘤组与健康对照组之间vWF的差异性，采用Spearman秩相关分析vWF：Ag与vWF：Ac之间的相关性。Cox比例风险回归模型筛选恶性肿瘤患者的预后影响因素。随访90 d，通过受试者工作特征曲线（ROC）评估vWF：Ag、vWF：Ac对患者发生VTE事件的预测价值。用Kaplan-Meier法进行生存分析。结果　与健康对照组相比，恶性肿瘤组血浆vWF：Ag和vWF：Ac水平均显著升高［197.38%（143.54%，328.97%）比117.00%（97.70%，147.40%）、191.87%（130.85%，265.69%）比117.90%（99.50%，153.00%），Z=8.76、7.91，均P<0.001］，且vWF：Ag与vWF：Ac呈正相关（r=0.783，P<0.001）。随访期间，VTE事件发生组的vWF：Ag、vWF：Ac水平高于未发生VTE事件组［432.38%（248.14%，539.55%）比183.00%（126.96%，246.02%）、258.38%（174.11%，373.84%）比175.42%（122.05%，251.00%），Z=5.65、3.89，均P<0.001］。Cox多因素回归分析显示，vWF：Ag是恶性肿瘤患者90 d随访期间发生VTE事件的独立影响因素（风险比=1.03，P<0.001）。vWF：Ag和vWF：Ac预测恶性肿瘤患者发生VTE事件的曲线下面积（area under the curve，AUC）分别为0.818、0.719，灵敏度分别为78.8%、69.7%，特异度分别为75.4%、67.9%，两者联合检测的预测价值更高（AUC=0.825）。vWF：Ag≥244.98%的恶性肿瘤患者的总体VTE事件发生时间早于vWF：Ag<244.98%的患者（χ²=20.49，P<0.001）。结论　恶性肿瘤患者血浆vWF：Ag、vWF：Ac水平均显著升高，且两者之间的增长具有较高的一致性。vWF：Ag是恶性肿瘤患者发生VTE事件的独立影响因素，vWF可能是预测恶性肿瘤患者VTE事件的潜在标志物。

关键词:

血管性血友病因子, 活性, 恶性肿瘤, 静脉血栓

Abstract:

Objective　To investigate the clinical value of plasma von Willebrand factor antigen (VWF:Ag) and activity (VWF:Ac) levels in the prediction of venous thromboembolic events in patients with cancers. Methods　A total of 167 patients with cancers who were treated in Nanyang Central Hospital from June 2020 to December 2021 were selected as a caner group, including 97 males and 70 females who were (52.53±10.58) years old. While 135 healthy volunteers matched with the cancer group during the same period were selected as a healthy control group, including 91 males and 44 females who were (47.56±8.09) years old. Their plasma vWF:Ag and vWF:Ac levels were measured. The differences of vWF were analyzed in the cancer group overall and between each subgroup and the healthy control group by Mann-Whitney U test. Spearman rank correlation was used to analyze the correlation between vWF:Ag and vWF:Ac. Cox proportional risk regression model was used to screen the prognostic influencing factors in the patients. The value of vWF:Ag and vWF:Ac in the prediction of the occurrence of VTE events was assessed by receiver operator characteristic curve (ROC) during the 90 d follow-up. Survival analysis was performed using the Kaplan-Meier method. Results　The plasma vWF:Ag and vWF:Ac levels in the case group were significantly higher than those in the healthy control group [197.38% (143.54%, 328.97%) vs. 117.00% (97.70%, 147.40%) and 191.87% (130.85%, 265.69%) vs. 117.90% (99.50%, 153.00%); Z=8.76 and 7.91; both P<0.001]. The correlation analysis revealed that there was a positive correlation between vWF:Ag and vWF:Ac in the case group (r=0.783, P<0.001). During the follow-up, the vWF:Ag and vWF:Ac levels in the group with VTE events were higher than those in the group without VTE events [432.38% (248.14%, 539.55%) vs. 183.00% (126.96%, 246.02%) and 258.38% (174.11%, 373.84%) vs. 175.42% (122.05%, 251.00%); Z=5.65 and 3.89; both P<0.001]. The Cox multifactorial regression analysis showed that vWF:Ag was an independent influencing factor on the occurrence of VTE events during the 90 d follow up in the patients (hazard rate=1.03, P<0.001). In assessing the diagnostic efficacy for the occurrence of venous thrombotic events in the patients, the areas under the curves (AUC) of vWF:Ag and vWF:Ac were 0.818 and 0.719; the sensitivities were 78.8% and 69.7%; the specificities were 75.4% and 67.9%; for predicting the occurrence of VTE events in the patients, the predictive value of the combined test was higher (AUC=0.825). The patients with vWF:Ag≥244.98% occurred VTE events earlier than the patients with vWF:Ag<244.98% (χ²=20.49, P<0.001). Conclusions　Plasma vWFvWF:Ag and vWF:Ac levels are significantly elevated in patients with cancers, and there is a high concordance between the increases. vWF:Ag is an independent influencing factor in the occurrence of VTE events in patients with cancers; vWF may be a potential marker for predicting venous thrombosis associated with VTE events in patients with cancers.

Key words:

von Willebrand factor, Activity, Cancers, Venous thrombosis

闫彬杜伟鹏翟素平胡天喜陶林静叶亚平周媛孙星.

vWF抗原和活性联合检测对恶性肿瘤患者静脉血栓事件的预测价值 [J]. 国际医药卫生导报, 2023, 29(22): 3240-3244.

Yan Bin, Du Weipeng, Zhai Suping, Hu Tianxi, Tao Linjing, Ye Yaping, Zhou Yuan, Sun Xing.

Value of combined detection of vWF antigen and activity in prediction of venous thromboembolic events in patients with cancers [J]. International Medicine and Health Guidance News, 2023, 29(22): 3240-3244.

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vWF抗原和活性联合检测对恶性肿瘤患者静脉血栓事件的预测价值

Value of combined detection of vWF antigen and activity in prediction of venous thromboembolic events in patients with cancers

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