中国普外基础与临床杂志

中国普外基础与临床杂志

可溶性细胞表面分化抗原 40 配体在下肢深静脉血栓形成患者外周血中的表达

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目的 分析 DVT 的诱发因素及其临床特点并探讨可溶性细胞表面分化抗原 40 配体(sCD40L)用于早期诊断 DVT 的临床价值。 方法 回顾性收集 2012 年 1 月至 2017 年 1 月期间入住南充市中心医院血管外科尚未接受抗凝、溶栓治疗的下肢 DVT 患者,根据 DVT 的临床病程分为急性早期、急性中期、急性后期及亚急性期,检测 DVT 患者外周血中 sCD40L 表达水平。 结果 本研究共收集符合纳入标准的 DVT 患者 100 例,其中急性早期 31 例、急性中期 26 例、急性后期 21 例及亚急性期 22 例,中央型 28 例、周围型 66 例、混合型 6 例。发生在左侧 52 例,右侧 31 例,双侧 17 例。①DVT 发病诱因从高到低分别是骨折(27.0%)、恶性肿瘤(21.0%)、胸腹部术后(20.0%)、关节置换术后(18.0%)及剖宫产(6.0%)。② 急性早期 DVT 者较多见于骨折后(54.8%),急性中、后期多见于关节置换术后(分别为 26.9%、38.1%),而亚急性期多以恶性肿瘤为主(50.0%)。③ 与对照组(同期 20 名体检健康人群)比较,不同临床病程 DVT 患者外周血中 sCD40L 表达均显著升高(P<0.05);处于不同病程的 DVT 患者 sCD40L 表达水平比较差异有统计学意义(F=26.21,P=0.27),在急性早期中 sCD40L 表达即达最高,随后逐渐下降(P<0.05)。④ 周围型、中央型及混合型患者外周血中 sCD40L 表达水平三者间总体比较差异有统计学意义(F=12.5,P=0.02),进一步两两分析结果显示,其在中央型和混合型中均明显高于周围型(P<0.05),但在中央型与混合型间比较差异无统计学意义(P>0.05)。 结论 CD40L 可能在早期诊断 DVT 以及判断血栓范围即严重程度方面有潜在的临床应用价值。

Objective To analyze inducing factors and clinical characteristics of deep venous thrombosis (DVT) and to explore clinical value of soluble cell surface differentiation antigen 40 ligand (sCD40L) in early diagnosis of DVT. Methods The patients with the DVT of lower extremity who had not received the anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2017 were collected, these patients were divided into an early-acute stage, mid-acute stage, late-acute stage, and subacute stage according to the clinical course of DVT. The sCD40L expression in the peripheral blood of DVT patients were detected by the enzyme linked immunosorbent assay. Results There were 100 patients with the DVT were included, including 31 cases of early-acute stage, 26 cases of mid-acute stage, 21 cases of late-acute stage, and 22 cases of subacute stage; 66 patients with the peripheral type, 28 patients with the central type, and 6 patients with the mixed type; 52 patients involved at the left lower extremity, 31 patients at the right lower extremity, and 17 at the bilateral lower extremities. ① The fracture, malignant tumor, long time in the bed following the thoracic or abdominal operation, joint replacement, and caesarean section were the successively main risk factors of the DVT. ② The early-acute stage of DVT was more common in the fracture patients, the mid-term and late-acute stage of DVT often occurred in the joint replacement sufferer, and the subacute stage of DVT was usually found in the malignant tumor patients. ③ The sCD40Lexpression in the patients with the different stage DVT was signifiantly higher than that in the control group (20 healthy people in the physical examination, P<0.05). Furthermore, there was a significant difference in the different stage DVT patients (F=26.21, P=0.27), that is, the expression of sCD40L was the highest in the early-acute stage of DVT, and then gradually reduced (P<0.05). ④ The sCD40L expression had a significant difference among the central type DVT, mixed type DVT, and peripheral type DVT (F=12.5, P=0.02), which in the peripheral type DVT was significantly higher than that of the central type DVT (P<0.05, and mixed type DVT (P<0.05), but no difference between the central type and the mixed type DVT group (P>0.05). Conclusio sCD40L might act as a blood index of early diagnosis and judgement of extent of DVT, especially be helpful in early-acute stage of DVT.

关键词: 深静脉血栓形成; 可溶性细胞表面分化抗原 40 配体; 炎症

Key words: deep venous thrombosis; soluble cell surface differentiation antigen 40 ligand; inflammatory

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1. Aloui C, Prigent A, Sut C, et al. The signaling role of CD40 ligand in platelet biology and in platelet component transfusion. Int J Mol Sci, 2014, 15(12): 22342-22364.
2. 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南 (第三版). 中国血管外科杂志 (电子版), 2017, 9(4): 250-257.
3. White RH. The epidemiology of venous thromboembolism. Circulation, 2003, 107(23 Suppl 1): I4-I8.
4. Grosse SD, Nelson RE, Nyarko KA, et al. The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs. Thromb Res, 2016, 137: 3-10.
5. Brahmandam A, Abougergi MS, Ochoa Chaar CI. National trends in hospitalizations for venous thromboembolism. J Vasc Surg Venous Lymphat Disord, 2017, 5(5): 621-629.
6. Lee LH, Gallus A, Jindal R, et al. Incidence of venous thromboembolism in Asian populations: a systematic review. Thromb Haemost, 2017, 117(12): 2243-2260.
7. 吴洲鹏, 赵纪春, 马玉奎, 等. 老年人静脉血栓栓塞症的研究进展. 中国普外基础与临床杂志, 2018, 25(8): 1004-1010.
8. Stein PD, Hull RD, Patel KC, et al. Venous thromboembolic disease: comparison of the diagnostic process in men and women. Arch Intern Med, 2003, 163(14): 1689-1694.
9. Geerts WH. Prevention of venous thromboembolism in high-risk patients. Haematologica, 1997, 61(9): 496-502.
10. Khorana AA, Dalal MR, Lin J, et al. Health care costs associated with venous thromboembolism in selected high-risk ambulatory patients with solid tumors undergoing chemotherapy in the United States. Clinicoecon Outcomes Res, 2013, 5: 101-108.
11. Khorana AA, Dalal M, Lin J, et al. Incidence and predictors of venous thromboembolism (VTE) among ambulatory high-risk cancer patients undergoing chemotherapy in the United States. Cancer, 2013, 119(3): 648-655.
12. Buesing KL, Mullapudi B, Flowers KA. Deep venous thrombosis and venous thromboembolism prophylaxis. Surg Clin North Am, 2015, 95(2): 285-300.
13. Brouwer JL, Bijl M, Veeger NJ, et al. The contribution of inherited and acquired thrombophilic defects, alone or combined with antiphospholipid antibodies, to venous and arterial thromboembolism in patients with systemic lupus erythematosus. Blood, 2004, 104(1): 143-148.
14. Souza FF, Otero HJ, Erturk M, et al. Venous thrombosis in an outpatient oncologic center: distribution, type, and comorbidities. Ultrasound Q, 2009, 25(3): 145-150.
15. Chen F, Xiong JX, Zhou WM. Differences in limb, age and sex of Chinese deep vein thrombosis patients. Phlebology, 2015, 30(4): 242-248.
16. Branchford BR, Carpenter SL. The role of inflammation in venous thromboembolism. Front Pediatr, 2018, 6: 142.
17. Memon AA, Sundquist K, PirouziFard M, et al. Identification of novel diagnostic biomarkers for deep venous thrombosis. Br J Haematol, 2018, 181(3): 378-385.
18. von Brühl ML, Stark K, Steinhart A, et al. Monocytes, neutrophils, and platelets cooperate to initiate and propagate venous thrombosis in mice in vivo. J Exp Med, 2012, 209(4): 819-835.
19. Ley K, Laudanna C, Cybulsky MI, et al. Getting to the site of inflammation: the leukocyte adhesion cascade updated. Nat Rev Immunol, 2007, 7(9): 678-689.
20. Giesen PL, Rauch U, Bohrmann B, et al. Blood-borne tissue factor: another view of thrombosis. Proc Natl Acad Sci USA, 1999, 96(5): 2311-2315.
21. Müller I, Klocke A, Alex M, et al. Intravascular tissue factor initiates coagulation via circulating microvesicles and platelets. FASEB J, 2003, 17(3): 476-478.
22. Papayannopoulos V, Zychlinsky A. NETs: a new strategy for using old weapons. Trends Immunol, 2009, 30(11): 513-521.
23. Fuchs TA, Bhandari AA, Wagner DD. Histones induce rapid and profound thrombocytopenia in mice. Blood, 2011, 118(13): 3708-3714.
24. Kambas K, Mitroulis I, Apostolidou E, et al. Autophagy mediates the delivery of thrombogenic tissue factor to neutrophil extracellular traps in human sepsis. PLoS One, 2012, 7(9): e45427.
25. Aloui C, Prigent A, Sut C, et al. The signaling role of CD40 ligand in platelet biology and in platelet component transfusion. Int J Mol Sci, 2014, 15(12): 22342-22364.