关键词: 凝血酶生成试验, 凝血因子监测, 创伤性骨折, 深静脉血栓形成, 预测

Abstract: Objective  To analyze the prognostic value of thrombin generation assay(TGA) and coagulation factor testing in postoperative deep venous thrombosis(DVT) of lower extremities in elderly patients with traumatic fracture.Methods A retrospective case-control study was conducted to collect traumatic patients older than 60 years old who underwent surgery in our department from March 2019 to March 2022.The number of patients was 104.According to the ultrasonic examination of DVT 5 days after operation,the patients were divided into DVT group and non-DVT group.The differences of general demographic data,previous chronic diseases,time from trauma to operation,related indexes of TGA and TF coagulation factors(F) between the two groups were analyzed.The indexes with statistical significance were analyzed by receiver operating curve(ROC);the indexes with statistically significant differences were analyzed by Logistic regression and the prediction probability was calculated by ROC curve analysis.Results The incidence of postoperative DVT was 21.12%.Compared with the non-DVT group,the time from trauma to operation was longer in the DVT group,and the peak value under 5 pmol/L TF activation was lower(258.13±40.88 vs 209.58±30.09).FⅤ,F Ⅷ and Fib were higher(141.25(125.38,158.18) vs 176.12(150.65,186.34),145.49(133.36,147.48) vs 165.96(153.07,180.65),3.25±0.55 vs 3.92±0.72,respectively).The differences were statistically significant(all P<0.01).ROC curve analysis showed that the time from trauma to operation,the peak value of 5 pmol/L TF activation,FⅤ,F Ⅷ and Fib combined had more predictive value for postoperative DVT,the AUC was 0.91(P＜0.01),the sensitivity was 0.82 and the specificity 0.92.Conclusion The time from trauma to operation,the peak value of TGA under the condition of 5 pmol/L TF activation,FⅤ,F Ⅷ and Fib have excellent prognostic value for the postoperative DVT of lower extremities in elderly patients with traumatic fracture,and the combined detection is more significative.

Key words: thrombin generation assay, coagulation factor testing, traumatic fracture, deep venous thrombosis, prediction