血清ACE2、Hcy联合血小板聚集率检测对孕产妇静脉血栓栓塞的诊断价值

Diagnostic value of serum ACE2, Hcy combined with platelet aggregation rate detection for venous thromboembolism in pregnant and postpartum women

摘要

目的 探讨血清血管紧张素转化酶2(ACE2)、同型半胱氨酸(Hcy)联合血小板聚集率检测对孕产妇静脉血栓栓塞(VTE)的诊断价值,为临床治疗孕产妇静脉血栓栓塞提供一定依据。方法 前瞻性选取2021年1月至2023年7月于本院就诊的102例静脉血栓栓塞孕产妇作为静脉血栓栓塞组,另选同期孕检的98名健康孕妇作为对照组.收集所有研究对象的临床资料,采用酶联免疫吸附法检测血清ACE2表达水平,循环酶法检测血清中Hcy表达水平,全自动分析仪检测血清中血小板聚集率.采用多因素Logistic回归分析影响静脉血栓栓塞发生的因素,受试者工作特征(ROC)曲线分析血清中血清ACE2、Hcy联合血小板聚集率对孕产妇发生静脉血栓栓塞的诊断价值。结果 静脉血栓栓塞组产妇剖宫产及产后出血占比较对照组更高(χ²值分别为10.511、10.878,P＜0.05);与对照组相比,孕产妇静脉血栓栓塞组在D-二聚体、纤维蛋白降解产物、ACE2、Hcy、血小板聚集率上显著升高(t值分别为12.973、41.478、12.768、14.349、10.279,P＜0.05),抗凝血酶Ⅲ活性显著降低(t值为15.637,P＜0.05);多因素Logistic回归分析结果显示,血清ACE2、Hcy、血小板聚集率是孕产妇发生静脉血栓栓塞的危险因素(OR值及其95%CI分别为1.856(1.359~2.535)、2.486(1.160~5.329)、1.861(1.459~2.373));ROC曲线分析显示,三者联合检测孕产妇发生静脉血栓栓塞的诊断价值[曲线下面积(AUC)为0.990(95%CI:0.965~0.999)]优于各自单独检测[曲线下面积(AUC)分别为0.894(95%CI:0.843~0.933)、0.916(95%CI:0.869~0.951)、0.807(95%CI:0.746~0.860)](Z三者联合-ACE2＝4.642,Z三者联合-Hcy＝4.280,Z三者联合-血小板聚集率＝6.284,均P＜0.001)。结论 血清ACE2、Hcy、血小板聚集率三者联合检测对孕产妇发生静脉血栓栓塞有一定的诊断参考价值.

Abstract

Objective To investigate the diagnostic effect of serum angiotensin-converting enzyme 2 (ACE2) and homocysteine (Hcy) combined with platelet aggregation rate on venous thromboembolism (VTE) pregnant and postpartum women, providing a basis for clinical treatment. Methods A prospective study was conducted on 102 pregnant and postpartum women with venous thromboembolism admitted to our hospital from January 2021 to July 2023 (VTE group), and 98 healthy pregnant women undergoing routine prenatal examinations during the same period were selected as the control group. Clinical data were collected for all subjects. Serum ACE2 levels were measured by enzyme-linked immunosorbent assay, Hcy levels were detected by enzymatic cycling assay, and platelet aggregation rate was analyzed using a fully automated analyzer. Multivariate logistic regression was used to analyze risk factors for VTE, and receiver operating characteristic (ROC) curves were employed to evaluate the diagnostic value of combined ACE2, Hcy, and platelet aggregation rate in VTE. Results The VTE group had significantly higher rates of cesarean delivery and postpartum hemorrhage than the control group (χ²＝10.511 and 10.878, respectively, P＜0.05). Compared with the control group, the VTE group showed significantly elevated levels of D-dimer, fibrin degradation products, ACE2, Hcy, and platelet aggregation rate (t＝12.973, 41.478, 12.768, 14.349, and 10.279, respectively, P＜0.05), while antithrombin Ⅲ activity was significantly lower (t＝15.637, P＜0.05). Multivariate logistic regression indicated that serum ACE2, Hcy, and platelet aggregation rate were independent risk factors for VTE (OR＝1.856, 95%CI: 1.359-2.535, OR＝2.486, 95%CI: 1.160-5.329, and OR＝1.861, 95%CI: 1.459-2.373, respectively). ROC analysis demonstrated that the combined detection of all three markers had superior diagnostic value for VTE (AUC＝0.990, 95%CI: 0.965-0.999) compared to individual detection (AUC_ACE2＝0.894, 95%CI: 0.843-0.933, AUC_Hcy＝0.916, 95%CI: 0.869-0.951, AUC_{platelet aggregation rate}＝0.807, 95%CI: 0.746-0.860) (Z_{three combination-ACE2}＝4.642, Z_{three combination-Hcy}＝4.280, Z_{three combination-platelet aggregation rate}＝6.284, all P＜0.001). Conclusion Combined detection of serum ACE2, Hcy, and platelet aggregation rate has significant diagnostic value for VTE in pregnant and postpartum women.

关键词

孕产妇 / 静脉血栓栓塞 / 血小板聚集率 / 血清血管紧张素转化酶2 / 同型半胱氨酸 / 诊断

Key words

pregnant and postpartum women / venous thromboembolism / platelet aggregation rate / serum angiotensin converting enzyme 2 / homocysteine / diagnosis

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基金资助

保定市科技计划项目(2341ZF123)