JAHA:可溶性尿激酶纤溶酶原激活物受体与COVID-19患者静脉血栓栓塞的关系

2022-08-07 MedSci原创 MedSci原创

在因COVID-19住院的患者中,较高的suPAR与独立于D-二聚体的静脉血栓栓塞事件相关。结合suPAR和D-二聚体可识别出低静脉血栓栓塞风险的患者。

静脉血栓栓塞对COVID-19的发病率和死亡率产生重大影响。尿激酶受体系统参与凝血的调节。可溶性尿激酶纤溶酶原激活物受体(suPAR)水平反映了过度炎症反应,并能预测COVID-19患者的预后。suPAR水平是否能识别发生静脉血栓栓塞风险的COVID-19患者尚未明确。

近日,心血管疾病领域权威杂志JAHA上发表了一篇研究文章,研究人员利用了一项多国观察性研究,测量了COVID-19住院患者入院时的suPAR和D-二聚体水平。

该研究共纳入了1960例(平均年龄为58岁;男性占57%;20%为黑人)受试者,研究人员使用logistic回归和Fine‐Gray模型评估了suPAR和突发静脉血栓栓塞(定义为肺栓塞或深静脉血栓形成)之间的关联,并考虑了竞争的死亡风险。

163例(8%)患者发生静脉血栓栓塞,与较高的suPAR和D-二聚体水平相关。suPAR与D‐二聚体呈正相关(β=7.34;P=0.002)。经临床协变量(包括D-二聚体)调整后,与suPAR第一个四分位数相比,第三个四分位数个体静脉血栓栓塞发生的几率高出168%(调整后的比值比为2.68[95%CI为1.51-4.75];P<0.001)。在D-二聚体水平分层和将死亡作为竞争风险的生存分析中,结果是一致的。基于随机森林的预测概率,一个决策树发现联合D-二聚体<1mg/L和suPAR<11ng/mL的临界值可识别出41%的患者,他们发生静脉血栓栓塞的概率只有3.6%。

由此可见,在因COVID-19住院的患者中,较高的suPAR与独立于D-二聚体的静脉血栓栓塞事件相关。结合suPAR和D-二聚体可识别出低静脉血栓栓塞风险的患者。

原始出处:

Shengyuan Luo.et al.Soluble Urokinase Plasminogen Activator Receptor and Venous Thromboembolism in COVID‐19.JAHA.2022.https://www.ahajournals.org/doi/full/10.1161/JAHA.122.025198

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    2023-07-18 fusion
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    2023-04-15 xue8602
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    2022-08-06 zhaohui6731
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    2022-08-06 redcrab
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