The Study On Epidemiology And F12 Gene Polymorphism Of Deep Vein Thrombosis In Traumatic Orthopaedics

Objective: To retrospectively analyze the incidence of deep vein thrombosis(DVT)and investigate the epidemiological characteristics of DVT in different fracture site of the Department of traumatic orthopedics.And to search the relationship between activity of F?,index of coagulation function,F12 gene loci rs17876030 and rs1801020 polymorphisms,and every indexe with DVT in department of traumatic orthopaedics.In order to explore the pathogenesis of thrombophilia,combined with DVT characteristic in different fracture site,to provide theoretical basis for early prediction,targeted and individualized effective prevention and rational treatment for clinical.Methods: The clinical records were retrospectively analyzed from February 2009 to February 2013 in Tianjin Hospital.Calculated the overall incidence of DVT and incidence of DVT in different fracture site.The second part experiment: designed of control study in three groups of patients.Thrombosis group included 200 cases: from September 2015 to September 2017,this group of patients were suffering from fracture,performed conventional anticoagulant treatment to prevent DVT,but still happened DVT.Control group included 100 cases: fracture patients in the same period,and adopted the same strategies of anticoagulant,there was no DVT.The normal healthy group included 100 cases,in the same period outpatient medical healthy people.Blood samples were collected.APTT and blood coagulation function were detected;Detected F? activity level through One-stage fixation method;By euzymelinked immunosorbent assay detected F? antigen;Detect F12 gene loci rs17876030 and rs1801020 gene polymorphism through direct sequencing method.Analysised the relationship between indexes and the correlation between with DVT.Used SPSS 19.0 software to statistical analysis.Results: 1543 fractures patients had happened DVT of 24049 patients during four years.The overall incidence of DVT was 6.4%.In 1543 cases of DVT,there were 1503 cases in lower limb fractures,accounting for 97.4%.The hip fracture in 742 cases,accounting for 48.1%,178 cases of femoral shaft fracture(11.5%);165 cases of femoral condyle fracture(10.7%);48 cases of pelvis and acetabulum fractur(3.1%);110 cases of patella fracture accounted(7.1%);79 cases of proximal tibial fractures(5.1%);91 cases of tibia and fibula fracture(5.9%);of 55 cases of ankle fractures(3.6%);15 cases of calcaneal fractures(1%);20 cases of foot fracture(1.3%).Only 40 cases of upper limb fractures occurred DVT,accounting for 2.6%.There were significant difference of incidence of DVT between lower and upper extremity,the incidence of DVT of lower extremity was 8.2%,and the upper extremity was 0.7%.The highest incidence of DVT fracture site was distal of femoral shaft with 23.1%,followed by 14.7% of femoral shaft fractures,around the hip fracture was 12.9%,pelvic and acetabular fracture was 7.3%,patella fracture was 7.3%,tibial plateau fracture was 5.8%,tibia and fibula fracture was 2.9%,ankle fracture was 2.6%,calcaneus fracture was 1.2%,foot fracture was 4.7%.In upper extremity fractures,the highest fracture site of incidence of DVT was shoulder fracture with 3.0%,other all upper extremity fractures were less than 1%.The second part results.(1)There were no significant difference between APTT,PT,TT in all groups(P >0.05);There were significant difference in fibrinogen and D-dimer between thrombosis group and other two groups(P <0.001).(2)The mean F? activity in three group was 78.3%±21.9%,97.8% ±31.4% and 94.5%±35.7% respectively(P <0.05).There was no obvious correlation between F? activity and fracture site,age and gender.There was significant negative correlation between F? activity and APTT(P<0.05).(3)The genotype of rs17876030 TT cases in three groups were 122(61%),34(34%)and 30(30%)respectively(P <0.01);rs1801020 CC were 115(57.5%),25(25%)and 16(16%)(P <0.01).(4)rs17876030 genotype TT in three groups were significantly decreased F? activity,and have statistical significance with CC and CT genotype(P <0.05);rs1801020 genotype CC in three groups were significantly decreased F? activity,and have statistical significance with TT and CT genotype(P <0.05).In thrombosis group,rs17876030 TT and rs1801020 CC genotype frequency were highest,and the F? activity level were significantly lower,there was a strong relationship between the DVT formation these two genotype(P <0.05).Conclusions: The patients of traumatic orthopedics are high risk population of DVT.The incidence of DVT is closely related to fracture site,there is significant difference between different sites of fractures.The fracture site should be regarded as the most important risk factor for DVT.Clinicians should be based on incidence of DVT in different fracture site and related risk factors for patients making effective DVT risk assessment and taking more reasonable,targeted prevention and treatment measures.There is a clear correlation between Fg,D-dimer and DVT formation,clinicians should be targeted to these two indicators increased vigilance and attention,according to whether the patient has other DVT risk factors for early prevention and targeted therapy,in order to reduce the incidence of DVT.Unlike other clotting factors,the level and APTT activity of F ? has obvious negative correlation,APTT was significantly prolonged and may indicate F? deficiency,and significantly reduced the level of activity of FXII may be closely related to the formation of DVT,these may be used as a high risk factor for thrombophilia in the future.There is a correlation between the F12 gene loci rs17876030,rs1801020 polymorphism and occurrence of DVT.rs17876030 TT and rs1801020 CC genotype may be considered as a predictor of thromboembolism.