Abstract:

Objective　To investigate the clinical application of plasma antithrombin Ⅲ (AT Ⅲ) activity in combination with conventional coagulation indicators in patients with deep vein thrombosis (DVT). Methods　This was a retrospective study. A total of 163 patients with DVT diagnosed in Department of Vascular Surgery, Nanyang Central Hospital from January 2021 to December 2021 were retrospectively analyzed, including 125 patients newly diagnosed with DVT and 38 patients receiving venous filter removal. During the same period, 137 healthy subjects were selected as the control group. Among the 163 patients with DVT, there were 78 males and 85 females, aged (56.56±13.49) years; among the 137 healthy subjects, there were 92 males and 45 females, aged (42.31±10.32) years. Independent sample t test or Mann-Whitney U test was used to compare the differences of ATⅢ and other measurement data in different populations or DVT subgroups; χ² test was used to compare the gender and other count data. Fisher's discriminant analysis was performed on the relevant detection indicators in the DVT group and the control group, the diagnostic value of reduced AT Ⅲ activity in DVT events was evaluated by the receiver operating characteristic curve, and the risk factors of DVT events were analyzed by logistic regression analysis. Results　The AT Ⅲ activity in the DVT group was lower than that in the healthy control group [(89.79±11.08) % vs. (96.52±8.28) %, t=37.895, P<0.001]. The proportions of history of surgery and history of cardiovascular and cerebrovascular diseases in the reduced AT Ⅲ group (AT Ⅲ ≤80%) were higher than those in normal AT Ⅲ group [71.43% (20/28) vs. 47.42% (46/97), 71.43% (20/28) vs. 48.45% (47/97), χ²=5.024 and 4.612, both P<0.05]. Application of Fisher's discriminant function to assess AT Ⅲ level and traditional coagulation indicators in screening DVT: healthy control group Y1=0.114× age +1.742× prothrombin time -0.176× activated partial thrombin time +6.479× thrombin time +7.798× fibrinogen -0.378× D-dimer +0.021× platelet count +1.035× AT Ⅲ -132.585; DVT group Y2= 0.203× age +1.949× prothrombin time -0.161× activated partial thrombin time +6.246× thrombin time +8.158× fibrinogen +0.105× D-dimer +0.018× platelet count +0.937× AT Ⅲ -127.587, with the overall coincidence rate of 85.11% (223/262). The area under the curve of AT Ⅲ to determine DVT events was 0.706, the cutoff value was 86.5%, and the sensitivity and specificity were 46.77% and 91.24%, respectively. After adjusting for gender and age, AT Ⅲ <86.5% was the main important independent risk factor for DVT events (odds ratio = 10.460, 95% confidence interval = 4.676-23.400). Conclusions　The level of AT Ⅲ in DVT patients is significantly reduced. AT Ⅲ combined with routine coagulation indicators contributes to screen for DVT events. AT Ⅲ <86.5% is the main independent risk factor for DVT events. Attention should be paid to the risk of venous thrombosis in the population with reduced AT Ⅲ level.

Key words:

Deep vein thrombosis, Antithrombin Ⅲ, Coagulation detection, Thrombosis risk

摘要：

目的　探讨血浆抗凝血酶Ⅲ（AT Ⅲ）活性联合常规凝血指标检测在深静脉血栓形成（DVT）患者中的应用价值。方法　本研究为回顾性研究。收集2021年1—12月在南阳市中心医院血管外科确诊的163例DVT患者（其中125例为初诊DVT患者，38例为取静脉滤器患者）作为病例组，同期137例健康正常人为对照组。DVT组中男性78例，女性85例，年龄（56.56±13.49）岁；对照组中男性92例，女性45例，年龄（42.31±10.32）岁。采用独立样本t检验或Mann-Whitney U检验比较AT Ⅲ等计量资料在不同人群或DVT亚组中的差异；采用χ²检验比较性别等计数资料。对DVT组与对照组的相关检测指标进行Fisher判别分析，利用受试者工作特征曲线评估AT Ⅲ活性降低在DVT事件中诊断效能，采用logistic回归分析DVT事件的危险因素。结果　DVT组的AT Ⅲ活性低于对照组［（89.79±11.08）%比（96.52±8.28）%，t=37.895，P<0.001］。AT Ⅲ减低组（AT Ⅲ≤80%）患者合并手术史、心脑血管疾病史的比例高于AT Ⅲ正常组［71.43%（20/28）比47.42%（46/97），71.43%（20/28）比48.45%（47/97），χ²=5.024、4.612，均P<0.05］。Fisher判别函数评估AT Ⅲ水平联合传统凝血指标在甄别DVT中的应用：健康对照组Y1=0.114×年龄+1.742×凝血酶原时间-0.176×活化部分凝血活酶时间+6.479×凝血酶时间+7.798×纤维蛋白原-0.378×D-二聚体+0.021×血小板计数+1.035×AT Ⅲ-132.585；DVT组Y2=0.203×年龄+1.949×凝血酶原时间-0.161×活化部分凝血活酶时间+6.246×凝血酶时间+8.158×纤维蛋白原+0.105×D-二聚体+0.018×血小板计数+0.937×AT Ⅲ-127.587，总符合率为85.11%（223/262）。AT Ⅲ判断DVT事件的曲线下面积为0.706，截断值为86.5%，灵敏度和特异度分别为46.77%和91.24%。在调整了性别和年龄后，AT Ⅲ <86.5%是发生DVT事件的最主要独立危险因素（优势比=10.460，95%可信区间为4.676～23.400）。结论　DVT患者的AT Ⅲ水平显著降低，AT Ⅲ联合常规凝血指标有助于甄别DVT事件。AT Ⅲ<86.5%是发生DVT事件的主要独立危险因素，应警惕AT Ⅲ水平降低人群的静脉血栓形成风险。

关键词:

深静脉血栓, 抗凝血酶 Ⅲ, 凝血检测, 血栓风险