微创医学

目的探讨断指再植术后患者发生血管危象的影响因素及其预测效能。方法回顾性分析行断指再植术的64例患者的临床资料，根据患者术后是否发生血管危象，将其分为观察组14例（血管危象患者，30指）和对照组50例（无血管危象患者，76指）。比较两组患者临床一般资料及术前、术后24 h和术后3 d的血清单核细胞趋化蛋白-1（MCP-1）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平。采用Spearman相关性分析血清MCP-1和IL-6水平与术后血管危象的关系；采用多因素Logistic回归分析断指再植术后发生血管危象的影响因素，绘制受试者操作特征曲线，以曲线下面积（AUC）评估影响因素预测断指再植术后发生血管危象的效能。结果两组患者术前血清MCP-1、IL-6、TNF-α水平比较，差异无统计学意义（P>0.05）。术后24 h，两组血清MCP-1、IL-6水平比较，组间差异具有统计学意义（P<0.05）。术后3 d，两组血清MCP-1水平比较差异无统计学意义（P>0.05），血清IL-6水平比较差异具有统计学意义（P<0.05）。两组术前、术后24 h、术后3 d的血清TNF-α水平比较，差异无统计学意义（P>0.05）。Spearman相关性分析显示，术后24 h和术后3 d血清IL-6以及术后24 h血清MCP-1与断指再植术后血管危象呈正相关（P<0.05）。多因素Logistic回归分析结果显示，术后24 h血清MCP-1、IL-6水平均可作为断指再植术后发生血管危象的影响因素（P<0.05）。术后24 h血清MCP-1和IL-6预测血管危象的最佳诊断值分别为8.37 pg/mL和9.24 pg/mL，血清MCP-1、IL-6水平和两者联合检测的AUC分别为0.842、0.774和0.916，95%CI分别为（0.718，0.966）、（0.653，0.896）和（0.830，1.000），灵敏度分别为78.60%、85.70%和92.90%，特异度分别为86.00%、66.00%和90.00%（P<0.05）。根据MCP-1和IL-6的最佳截断值将患者分为MCP-1和IL-6高水平组和低水平组，高水平MCP-1患者发生血管危象的危险度是低水平的9.37倍，高水平IL-6患者发生血管危象的危险度是低水平的7.24倍（P<0.05）。结论断指再植术后血清MCP-1和IL-6水平升高与血管危象的发生有关，术后24 h血清MCP-1和IL-6联合检测可预测术后患者是否发生血管危象。

Objective To observe the influencing factors and predication model performance of vascular crisis in patients after replantation of amputated finger. Methods A retrospective analysis was performed on the clinical data of 64 patients who underwent replantation of amputated finger. According to whether vascular crisis occurred after operation, the patients were divided into observation group (14 cases with vascular crisis, 30 fingers) and control group (50 cases without vascular crisis, 76 fingers). Compare the clinical general data of the two groups of patients, as well as changes in serum levels of monocyte chemotactic protein-1 (MCP-1), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) at different time points (before operation, 24 hours and 3 days after operation). Spearman correlation was applied to analyze the relationship between serum levels of MCP-1 and IL-6, and postoperative vascular crisis. Multivariate Logistic regression model was used to analyze the influencing factors of vascular crisis after replantation of amputated fingers. The receiver operating characteristic curve was drawn, and the area under the curve (AUC) was used to evaluate the efficacy of influencing factors in predicting vascular crisis after replantation of amputated limbs. Results There was no statistically significant difference in the preoperative serum levels of serum MCP-1, IL-6 and TNF-α between the two groups (P>0.05). At 24 hours postoperatively, a statistically significant difference was observed in the serum levels of MCP-1 and IL-6 between the two groups (P<0.05). At 3 days postoperatively, no statistically significant difference was found in serum MCP-1 levels between the two groups (P>0.05), while a statistically significant difference was noted in serum IL-6 levels (P<0.05). Additionally, there was no statistically significant difference in serum TNF-α levels between the two groups at preoperative, 24 hours postoperatively, and 3 days postoperatively (P>0.05). Spearman correlation analysis showed that serum IL-6 levels at 24 hours and 3 days postoperatively, as well as serum MCP-1 levels at 24 hours postoperatively, were positively correlated with vascular crisis after replantation of amputated finger (P<0.05). The results of multivariate Logistic regression analysis showed that serum MCP-1 and IL-6 levels at 24 hours postoperatively could both serve as influencing factors for vascular crisis after replantation of amputated finger (P<0.05). The optimal diagnostic cutoff values of serum MCP-1 and IL-6 at 24 hours postoperatively for predicting vascular crisis were 8.37 pg/mL and 9.24 pg/mL, respectively. Corresponding AUC for serum MCP-1, IL-6 levels and thier combined detection were 0.842, 0.774 and 0.916, with 95%CI of (0.718, 0.966), (0.653, 0.896) and (0.830, 1.000), respectively. These markers also showed sensitivities of 78.60%, 85.70% and 92.90%, along with specificities of 86.00%, 66.00% and 90.00%, respectively (P<0.05). According to the optimal cutoff values for MCP-1 and IL-6, patients were divided into high-level group and low-level group for each marker. Patients with high MCP-1 levels faced a 9.37-fold higher risk of vascular crisis compared with those in the low MCP-1 group, whereas patients with high IL-6 levels had a 7.24-fold risk of vascular crisis compared with those with low IL-6 levels (P<0.05). Conclusion Elevated serum levels of MCP-1 and IL-6 after replantation of amputated finger are associated with the occurrence of vascular crisis, and the combined detection of serum MCP-1 and IL-6 at 24 hours postoperatively can predict whether vascular crisis will occur in patients.

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