| 摘要: |
| ［摘要］ 目的 分析能谱CT单能量成像指标联合微小RNA（miR）-146a预测血管外科手术后患者下肢深静脉血栓形成（LEDVT）的价值。方法 招募2022年1月至2024年11月在南京大学医学院附属苏州医院（苏州科技城医院）接受血管外科手术的258例患者作为研究对象，其中70例主动脉腔内修复术、96例颈动脉内膜剥脱术、48例急性动脉取栓术、44例腹主动脉瘤开放修复术。根据术后3个月内LEDVT发生情况将患者分为LEDVT组（50例）和非LEDVT组（208例）。患者术前均接受能谱CT单能量成像检查和血清miR-146a水平检测。通过LASSO回归筛选自变量，采用多因素logistic回归分析血管外科手术后患者发生LEDVT的影响因素。通过受试者工作特征（ROC）曲线分析能谱CT单能量成像指标联合miR-146a对血管外科手术后患者发生LEDVT的预测效能。结果 LEDVT组纤维蛋白原（Fib）、D-二聚体（D-D）水平显著高于非LEDVT组（P<0.05），凝血酶时间（TT）显示长于非LEDVT组（P<0.05）。LEDVT组40～70 keV能级下的下腔静脉CT值、股静脉CT值、腘静脉CT值高于非LEDVT组，miR-146a水平低于非LEDVT组，差异有统计学意义（P<0.05）。LASSO回归分析筛选出4个自变量，分别为40～70 keV能级下的下腔静脉CT值、股静脉CT值、腘静脉CT值及miR-146a。多因素logistic回归分析结果显示，40～70 keV能级下的下腔静脉CT值、股静脉CT值、腘静脉CT值升高是促进血管外科手术后患者发生LEDVT的危险因素（P<0.05），较低的miR-146a水平是抑制血管外科手术后患者发生LEDVT的保护因素（P<0.05）。ROC曲线分析结果显示，40～70 keV能级下的下腔静脉CT值、股静脉CT值、腘静脉CT值及miR-146a均能有效预测血管外科手术后患者发生LEDVT（P<0.05），且四项指标联合检测的预测效能［AUC（95%CI）=0.897（0.853～0.931）］优于单一指标（P<0.05）。结论 能谱CT单能量成像指标、miR-146a与血管外科手术后患者发生LEDVT有关，40～70 keV能级下的下腔静脉CT值、股静脉CT值、腘静脉CT值联合miR-146a对术后LEDVT具有良好的预测价值。 |
| 关键词: 能谱CT单能量成像 miR-146a 血管外科手术 下肢深静脉血栓形成 |
| DOI：10.3969/j.issn.1674-3806.2026.05.12 |
| 分类号:R 654.4 |
| 基金项目:江苏省优势学科建设工程项目（编号：YSHL2201-274）；2025年度苏州市医学会“影像医星”科技立项项目（编号：2025YX-M04） |
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| The value of spectral computed tomography single-energy imaging parameters combined with miR-146a in predicting lower extremity deep vein thrombosis in patients after vascular surgery |
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DING Xiang1, WU Qiong1, TIAN Jinjie1, SUN Yapeng2, CHENG Bo1
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1.Department of Imaging Medicine, the Affiliated Suzhou Hospital of Nanjing University Medical School(Suzhou Science & Technology Town Hospital), Suzhou 215153, China; 2. Department of Interventional Vascular Surgery, the Affiliated Suzhou Hospital of Nanjing University Medical School(Suzhou Science & Technology Town Hospital), Suzhou 215153, China
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| Abstract: |
| ［Abstract］ Objective To analyze the value of spectral computed tomography(CT) single-energy imaging parameters combined with microRNA-146a(miR-146a) in predicting lower extremity deep vein thrombosis(LEDVT) in patients after vascular surgery. Methods A total of 258 patients who underwent vascular surgery in the Affiliated Suzhou Hospital of Nanjing University Medical School(Suzhou Science & Technology Town Hospital) from January 2022 to November 2024 were recruited as the research subjects, including 70 patients undergoing aortic endovascular repair, 96 patients undergoing carotid endarterectomy, 48 patients undergoing acute arterial embolectomy, and 44 patients undergoing open abdominal aortic aneurysm repair. These patients were divided into LEDVT group(50 patients) and non-LEDVT group(208 patients) according to whether they developed LEDVT within 3 months after vascular surgery. Both groups underwent spectral CT single-energy imaging examination and detection of serum miR-146a level before vascular surgery. The independent variables were screened using LASSO regression, and multivariate logistic regression was used to analyze the influencing factors of developing LEDVT in patients after vascular surgery. The efficacy of spectral CT single-energy imaging parameters combined with miR-146a in predicting the development of LEDVT in patients after vascular surgery was analyzed by using receiver operating characteristic(ROC) curve. Results The levels of fibrinogen(Fib) and D-dimer(D-D) in the LEDVT group were significantly higher than those in the non-LEDVT group(P<0.05). The thrombin time(TT) in the LEDVT group was significantly longer than that in the non-LEDVT group(P<0.05). The CT values of inferior vena cava, femoral vein and popliteal vein under 40-70 keV energy level in the LEDVT group were higher than those in the non-LEDVT group, and the miR-146a level in the LEDVT group was lower than that in the non-LEDVT group, with statistically significant differences between the two groups(P<0.05). Four independent variables were screened out by using LASSO regression analysis, which were the CT values of inferior vena cava, femoral vein and popliteal vein under 40-70 keV energy level and miR-146a. The results of multivariate logistic regression analysis showed that the elevated CT values of inferior vena cava, femoral vein and popliteal vein under 40-70 keV energy level were risk factors of developing LEDVT in patients after vascular surgery(P<0.05), and lower level of miR-146a was a protective factor of inhibiting LEDVT in patients after vascular surgery(P<0.05). The results of ROC curve analysis showed that the CT values of inferior vena cava, femoral vein and popliteal vein under 40-70 keV energy level and miR-146a could effectively predict the development of LEDVT in patients after vascular surgery(P<0.05), and the predictive efficacy of the combined detection of the 4 indicators［AUC(95%CI)=0.897(0.853-0.931)］ was better than that of a single indicator(P<0.05). Conclusion Spectral CT single-energy imaging parameters and miR-146a are related to the development of LEDVT in patients after vascular surgery. The CT values of inferior vena cava, femoral vein and popliteal vein under 40-70 keV energy level combined with miR-146a level have good predictive value for postoperative LEDVT. |
| Key words: Spectral computed tomography single-energy imaging microRNA-146a(miR-146a) Vascular surgery Lower extremity deep vein thrombosis(LEDVT) |
