| Objective:We take the patients with acute deep vein thrombosis(DVT)as the research object,to research the role of P-selectin and intercellular cell adhesion molecule-1(ICAM-1)in the occurrence.Ourobjectiv is to explore the value of P-selectin and ICAM-1 in the diagnosis,efficacy evaluation and prognosis prediction of DVT.Methods:This paper collect DVT patients who were diagnosed in our hospital from February 2020 to February 2021 without anticoagulation and thrombolytic therapy.Patients were divided into 3 groups,according to the clinical course of disease.group A(duration of disease 1-3 days),group B(duration of disease 4-7 days),group C(duration of disease 8-14 days),and healthy people who underwent physical examination during the same period were selected as control group.The clinical data(sex,age,disease site,predisposing factors,etc.)of each group were compared,and the peripheral blood P-selectin,ICAM-1,D-dimer,C-reactive protein were detected to understand their Baseline levels and diversification in DVT patients;To understand their changes during treatment,the above index levels were detected on the 1st and 5th days after treatment;Blood vessel color Doppler ultrasound examination and 1-year follow-up results are used to understand it’s correlation with the short-term thrombolysis rate and long-term incidence of PTS.Subgroup analysis was performed according to the degree of swelling of the lower extremity which affected of DVT,different prognosis and and the changes of the above indicators in each subgroup were statistically analyzed.Independent samples t-test and repeated measures analysis of variance are uesd to check the differences between the data of each group by SPSS 24.0 software.Pearson correlation analysis was used for correlation analysis,and ROC test was used to check the prediction of poor prognosis of each index.P<0.05 was considered statistically significant.result:1.The expression levels of ICAM-1,P-selectin and D-Dimer between the experimental group and the control group were statistically different before treatment.There were significant differences in the expression of ICAM-1 between the experimental group and the control group,and the expression levels of ICAM-1 in the three groups A,B,and C were also statistically different.The average difference between A and B is I-J=-9.76,P=0.02;the average difference between A and C is I-J=-23.72,P<0.01,the average difference between B and C is I-J=-13.96,P<0.01.It suggested that there were obvious differences in the expression of ICAM-1 in patients with different course of disease.There were significant differences in the expression of-selectin between groups A,B,C and the control group,while there was no statistical difference in the expression of ICAM-1 in groups A,B,and C.It suggested that compared with the control group,the P-selectin was elevated in the patients,but the elevated level had no significant relationship with the duration of the disease.There were significant differences in the expression levels of D-Dimer between groups A,B,and C and the control group.There were differences in the expression of D-Dimer between groups A and B(I-J=-4444.79,P=0.07).There were differences in the expression of D-Dimer among the two groups(I-J=-8959,P<0.01.).There was no difference in the expression of D-Dimer between groups A and C(I-J=-4515.06,P=0.113).2.Subgroup analysis was performed according to the severity of the disease.Before treatment,there were significant differences in the expression of ICAM-1 between groups Ⅰ,Ⅱ,Ⅲ and the control group,and there was no statistical difference in the expression of ICAM-1 between groups Ⅰ and Ⅱ.There was a statistically significant difference in the expression of ICAM-1 between Ⅰ and Ⅲ(the mean difference was I-J=-11.87,P=0.03),and there was a statistically significant difference in the expression of ICAM-1 between Ⅱ and Ⅲ(the mean difference was I-J=-15.47,P=0.03).There were significant differences in the expression of P-selectin between groups Ⅰ,Ⅱ,Ⅲand the control group,but there was no statistical difference in the expression of P-selectin among the three groups.There were significant differences in the expression of D-Dimer between groups Ⅰ,Ⅱ,Ⅲ and the control group,and there was no significant difference in the expression of ICAM-1 between groups Ⅰ and Ⅱ.There was a statistically significant difference in the expression of ICAM-1 between Ⅰ and Ⅲ(the mean difference was I-J=-2030.52,P<0.01),and there was a statistically significant difference in the expression of ICAM-1 between Ⅱ and Ⅲ(the mean difference was I-J=-7060.06,P<0.01).3.The expression levels of ICAM-1,P-selectin and D-Dimer before and after treatment for 5 days=0.43,t=4.82,P<0.01)and D-Dimer(I-J=3835.19,t=2.25,P<0.01)were statistically different.For ICAM-1:Whether it is grouped according to the course of disease or according to the severity of the disease,the expression of ICAM-1 before and after treatment is significantly different.Group A(I-J=25.41,t=5.3,P<0.01)and group Ⅰ(I-J=21.04,t=3.3,P<0.01)showed a significant decrease in ICAM-1.For P-selectin:the expression of D-Dimer in groups A and B was statistically different before and after treatment.Group A(I-J=0.4,t=2.76,P=0,01),group B(I-J=0.47,t=2.82,P=0.01).There were significant differences in the expression of P-selectin before and after treatment in groups Ⅰ and Ⅱ.Group Ⅰ(I-J=0.63,t=3.29,P<0.01),group Ⅱ(I-J=0.53,t=3.85,P<0.01),group C and group Ⅲhad no statistical difference.For D-Dimer:There were statistical differences in the expression of D-Dimer before and after treatment in groups A,B andⅡ.Group A(I-J=0.4,t=2.76,P=0.01),Group B(I-J=0.47,t=2.82,P=0.01),Group Ⅱ(I-J=0.4,t=3455.04,P=1.13)Group D-2 There was a statistically significant difference in the expression of aggregates before and after treatment.There was no statistical difference between groups C,Ⅰ,and Ⅲ.4.The correlation analysis of factors before treatment showed that ICAM-1 was moderately correlated with the onset time before treatment(r=0.6),and ICAM-1 had a low correlation with the severity of the disease.In the correlation analysis of the villalta score at 1 year after treatment,the pre-treatment ICAM-1(r=0.541,P<0.01)had the highest correlation with the villalta score after 1 year,followed by the disease severity(affected limb)before treatment.increase in circumference)(r=0.537,P<0.01).Among the indicators after treatment,ICAM-1(r=0.632,P<0.01)and D-Dimer(r=0.515,P<0.01)were highly correlated with villalta score after 1 year.5.ROC analysis:ROC analysis showed that ICAM-1 had the best predictive efficiency for poor prognosis after 5 days of treatment(AUC=0.904±0.49,P<0.01,the predictive critical value was:ICAM-1=123.115 ng/ml)In addition,the prediction effect of thigh circumference after treatment(AUC=0.8910±051,P=0.00,predictive critical value:2.8cm)and thigh circumference difference before treatment(AUC=0.8810±0.055,P=0.001)was also better.Conclusion:ICAM-1,P-selectin and D-Dimer are significantly elevated in DVT patients and can be used as diagnostic indicators for DVT.Among them,ICAM-1 and P-selectin are both involved in the inflammatory process of thrombosis and play an important role.This study mainly focused on the changes of ICAM-1 and P-selectin in patients with different onset times and severity.We found that ICAM-1 has a certain significance in evaluating the severity of the disease and evaluating the prognosis of the patient’s disease,and there are significant differences in ICAM-1 between different subgroups,which may be due to its important role in the occurrence and development of DVT.The role of ICAM-1,in particular,is involved in the activation of NETs.The effect of P-selectin in assessing disease severity and prognosis was lower than that of ICAM-1.Finally,we found that thigh circumference difference is meaningful for prognostic prediction. |
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