Wang Chao-Wei, Su Lin-Lin, Tao Sheng-Bo, Ma Peng-Ju, Chang Hai-Gang, Ji Si-Bei
Department of Neurology, the First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan Province, China.
Department of Neurosurgery, the First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan Province, China.
World Neurosurg. 2016 Mar;87:607-12. doi: 10.1016/j.wneu.2015.10.059. Epub 2015 Nov 4.
This prospective cohort-designed study was performed to verify whether higher levels of serum lipoprotein(a) (Lp(a)) could be a risk factor for deep vein thrombosis (DVT) in Chinese patients with spinal cord injuries (SCI).
During 2013-2014, consecutive patients with first-ever SCI were recruited and assessed for DVT using color Doppler ultrasonography for 15 days after injury and whenever clinically requested. Using logistic regression models, multivariate analyses were performed. Receiver operating characteristic curves tested the overall predicted accuracy of Lp(a) and other markers.
In this study, 358 patients were screened in the analysis, and 279 patients with SCI were included and completed the 15-day follow-up. Fifty-five patients (19.7%) were diagnosed with DVT. Patients with SCI with DVT had significantly higher Lp(a) levels on admission (554 mg/L [interquartile range, 416-790 mg/L] vs. 158 mg/L [interquartile range, 72-252 mg/L]; P < 0.0001). Adjusted for common risk factors, multivariate analyses showed that serum Lp(a) ≥ 300 mg/L could be used independently to predict DVT (odds ratio, 10.35; 95% confidence interval [CI], 2.37-45.35; P < 0.0001). With an area under the curve (AUC) of 0.91 (95% CI, 0.86-0.94), Lp(a) showed a significantly greater discriminatory ability in predicting DVT compared with high-sensitivity C-reactive protein (AUC, 0.81; 95% CI, 0.74-0.88; P < 0.01), homocysteine (AUC, 0.78; 95% CI, 0.71-0.84; P < 0.01) and age (AUC, 0.66; 95% CI, 0.59-0.73; P < 0.001).
Increased serum Lp(a) levels were independent predictors of DVT in patients with SCI in China, suggesting a possible role of Lp(a) in the pathogenesis of DVT.
本前瞻性队列研究旨在验证较高水平的血清脂蛋白(a) [Lp(a)] 是否可能是中国脊髓损伤 (SCI) 患者发生深静脉血栓形成 (DVT) 的危险因素。
在2013年至2014年期间，招募首次发生SCI的连续患者，并在受伤后15天以及临床需要时使用彩色多普勒超声对DVT进行评估。使用逻辑回归模型进行多变量分析。受试者工作特征曲线测试了Lp(a) 和其他标志物的总体预测准确性。
在本研究中，分析中筛选了358例患者，纳入279例SCI患者并完成了15天的随访。55例患者 (19.7%) 被诊断为DVT。发生DVT的SCI患者入院时Lp(a) 水平显著更高 (554 mg/L [四分位间距，416 - 790 mg/L] 对比158 mg/L [四分位间距，72 - 252 mg/L]；P < 0.0001)。校正常见危险因素后，多变量分析显示血清Lp(a) ≥ 300 mg/L可独立用于预测DVT (比值比，10.35；95% 置信区间 [CI]，2.37 - 45.35；P < 0.0001)。Lp(a) 的曲线下面积 (AUC) 为0.91 (95% CI，0.86 - 0.94)，与高敏C反应蛋白 (AUC，0.81；95% CI，0.74 - 0.88；P < 0.01)、同型半胱氨酸 (AUC，0.78；95% CI，0.71 - 0.84；P < 0.01) 和年龄 (AUC，0.66；95% CI，0.59 - 0.73；P < 0.001) 相比，Lp(a) 在预测DVT方面具有显著更高的辨别能力。
血清Lp(a) 水平升高是中国SCI患者DVT的独立预测因素，提示Lp(a) 在DVT发病机制中可能发挥作用。
