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| 不同血型老年髋部骨折患者术后下肢静脉血栓形成的差异性及分子机制研究 |
| 王勇超,粟钦,林昕,田强,罗张风,李峰 |
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| 湖南医药学院第一附属医院关节运动医学科湖南怀化 418000 |
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| 摘要: |
| 目的:探讨不同血型老年髋部骨折患者术后下肢静脉血栓(VTE)形成的差异性及分子机制。方法:选择我院于2020年1 月—2022 年12 月收治的股骨转子间骨折患者160 例，根据血型分组:A 型组40 例，B 型组40 例，AB 型组40 例和O 型组40 例。所有患者均行闭合复位髓内钉内固定术治疗。比较不同血型组VTE 发生情况；比较不同血型组术前和术后1 周血栓弹力图(TEG)指标，D-二聚体水平，促凝关键因子和抗凝关键因子水平变化。结果:160 例股骨转子间骨折患者，术后VTE 发生43 例，发生率为26.87%。O 型组VTE 发生率低于A 型组、B 型组和AB 型组(P＜0.05)。不同血型组术前凝血反应时间(R)、凝血形成时间(K)、凝固角(a角)、最大凝块强度(MA)值、D-二聚体、血管性血友病因子(vWF)、VⅢ因子(FVⅢ)、组织因子(TF)、组织因子抑制物(TFPI)、蛋白C(PC)、蛋白S(PS)和血栓调节蛋白(TM)比较无统计学差异(P>0.05)；A 型组、B 型组和AB 型组术后1 周R 值、TFPI、PC、PS 和TM 低于术前，而K 值、a角、MA 值、D-二聚体、vWF、FVⅢ、TF 高于术前(P＜0.05)；O 型组术后1 周R 值、K 值、a角、MA 值、D-二聚体、vWF、FVⅢ、TF、TFPI、PC、PS 和TM 较术前无统计学差异( 跃0.05)；O 型组术后1 周R值、TFPI、PC、PS 和TM 高于A 型组、B 型组和AB 型组，而K 值、a角、MA 值、D-二聚体、vWF、FVⅢ、TF 低于A 型组、B 型组和AB 型组(P＜0.05)。结论:股骨转子间骨折术后VTE 形成中O 型发生率最低，且O 型R 值、TFPI、PC、PS 和TM 较A 型组、B 型组和AB 型组高，而K 值、a角、MA 值、D-二聚体、vWF、FVⅢ、TF 较A 型组、B 型组和AB 型组低，其差异性可能与不同血型患者VTE 形成有重要关系。 |
| 关键词: 不同血型 老年髋部骨折 下肢静脉血栓 差异性 分子机制 |
| DOI：10.3969/j.issn.1007-6948.2024.05.017 |
| 投稿时间：2023-12-02 |
| 基金项目:湖南省自然科学基金(2020JJ4061)；湖南省科技厅，湖南省多发重症创伤救治临床医疗示范基地(2019SK4019) |
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| Differences and molecular mechanisms of postoperative lower limb limb venous thrombosis formation in elderly patients with hip fractures of different blood types |
| WANG Yong-chao,SU Qin,LIN Xin |
| Department of Joint Sports Medicine, the First Affiliated Hospital of Hunan Medical College, Huaihua, Hunan
418000,China |
| Abstract: |
| Objective To explore the differences and molecular mechanisms of lower limb venous thrombosis (VTE) formation in elderly patients with hip fractures of different blood types after surgery. Methods 160 patients with intertrochanteric fractures of the femur in our hospital from January 2020 to December 2022 were selected and grouped according to blood type: A-type group of 40 cases, B-type group of 40 cases, ABtype group of 40 cases, and O -type group of 40 cases. All patients underwent closed reduction and intramedullary nail fixation surgery. Compare the incidence of VTE among different blood group groups; compare the changes in thromboelastography (TEG) indicators, D-dimer levels, key coagulation promoting factors, and key anticoagulant factors levels among different blood group groups before and 1 week after surgery. Results Among the 160 patients with intertrochanteric fractures of the femur, 43 had postoperative VTF, with an incidence rate of 26.87%. The incidence of VTE in the O-type group was lower than that in the A-type group,B -type group, and AB -type group (P<0.05).Preoperative R value, K value, aangle, MA value,D-dimer, von willebrand factor (vWF), FV III factor(FV III), tissue factor (TF), tissue factor pathway inhibitor (TFPI), protein C (PC), protein S (PS), and thrombomodulin (TM) were no significant difference (P>0.05); the A-type, B-type, and AB-type groups R-values, TFPI, PC, PS, and TM lower before surgery at 1week, while the K-values, aangle, MA value, D-dimer, vWF, FV III, and TF higher before surgery (P<0.05);the R-value, K-value, aangle, MA value, D-dimer, vWF, FV III, TF, TFPI, PC, PS, and TM compared to before surgery no significant differences (P>0.05); the O-type group R-value, TFPI, PC, PS, and TM higher A-type group, B-type group, and AB type group at 1 week after surgery, while the K-value, aangle, MA value, Ddimer,vWF, FV III, and TF lower A-type group, B-type group, and AB-type group (P<0.05). Conclusion The incidence of postoperative VTE in femoral intertrochanteric fractures is the lowest in type O, and the Rvalue,TFPI, PC, PS, and TM of O-type group higher A-type, B-type, and AB-type groups, while the K-value,aangle, MA value, D -dimer, vWF, FV III, and TF lower A -type, B -type, and AB -type group, and their differences may be closely related to the formation of VTE in patients with different blood types. |
| Key words: Different blood types elderly hip fractures lower limb venous thrombosis differences molecular mechanism |
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