D-二聚体动态监测对预测骨科手术后卧床患者发生深静脉血栓的诊断价值
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摘要
目的探讨D-二聚体动态监测对预测骨科手术后卧床患者发生深静脉血栓(DVT)的诊断价值。方法选取2017年1月至2017年11月期间我院接受骨科手术治疗的患者659例,术后定期进行彩超检查,根据是否发生DVT分为DVT组124例、对照组535例。所有患者分别于术前、术后采血进行血浆D-二聚体测定,并制作受试者工作特征曲线(ROC)、以彩超诊断DVT的结果为"金标准"进行对比,分析D-二聚体对预测患者发生DVT的诊断价值。结果两组术前1d血浆D-二聚体水平接近,差异无统计学意义(P>0. 05),术后均明显升高,术后3d达到最高值,对照组术后14d恢复正常水平,而DVT组未恢复至正常水平,且术后各时间点血浆D-二聚体水平显著高于对照组,差异有统计学意义(P<0.05)。以术后第3d D-二聚体水平制作诊断DVT的ROC曲线,显示诊断截断值为4.25mg/L FEU,ROC曲线下面积为0.94,95%CI:0.875～0.972。以血浆D-二聚体≥4.25mg/L FEU为骨科手术后卧床患者DVT(+),<4.25mg/L FEU为DVT(-),显示D-二聚体诊断骨科手术后卧床患者DVT的灵敏度、特异性、准确率依次为84. 68%、92. 26%、94. 08%。结论骨科手术后患者血浆D-二聚体水平明显升高,动态监测D-二聚体水平对诊断和预测术后卧床患者发生DVT有重要意义。
Objective To investigate the value of dynamic monitoring of D-dimer in predicting deep venous thrombosis(DVT) in bedridden patients after orthopedic surgery. Methods 659 patients who underwent orthopedic surgery in our hospital during January ～November 2017 were selected. Color Doppler ultrasoundregularly were performed after surgery. According to the occurrence of DVT,they were divided into DVT group(124 cases) and control group(535 cases). Blood was collected before and after surgery for determining D-dimer in plasma,and the receiver operating characteristic(ROC) curve was drawn. With the results of color Doppler ultrasound diagnosis for DVT as the golden standard, the value of D-dimer in predicting the occurrence of DVT was analyzed. Results Plasma D-dimer levels in the two groups were similar on day 1 before surgery(P > 0.05). After surgery, the levelwas increased significantly and reached the highest value on day 3 after surgery. The plasma D-dimer in the control group returned to normal level on day14 after surgery,but it did not returned to normal in DVT group. Plasma D-dimer levels were significantly higher in DVT group than that in control group at different time points after surgery(P < 0. 05). The ROC curve for diagnosing DVT was made by the D-dimer level on day 3 after surgery, indicating that the diagnostic cut-off value was 4.25 mg/L FEU,and the area under ROC curve was 0. 94.95 % Cl was 0. 875-0.972. With plasma D-dimer level-4. 25 mg/L FEU as DVT( +) and < 4. 25 mg/L FEUas DVT(-), it was found that the sensitivity, specificity and accuracy of D-dimer in diagnosing DVT in bedridden patients after orthopedic surgery were 84.68%,92.26% and 94. 08%,respectively. Conclusion The plasma level of D-dimer significantly increases in patients after orthopedic surgery. Dynamic monitoring of D-dimer is of great significance for diagnosis and prediction of DVT in bedridden patients after surgery.
Objective To investigate the value of dynamic monitoring of D-dimer in predicting deep venous thrombosis(DVT) in bedridden patients after orthopedic surgery. Methods 659 patients who underwent orthopedic surgery in our hospital during January ～November 2017 were selected. Color Doppler ultrasoundregularly were performed after surgery. According to the occurrence of DVT,they were divided into DVT group(124 cases) and control group(535 cases). Blood was collected before and after surgery for determining D-dimer in plasma,and the receiver operating characteristic(ROC) curve was drawn. With the results of color Doppler ultrasound diagnosis for DVT as the golden standard, the value of D-dimer in predicting the occurrence of DVT was analyzed. Results Plasma D-dimer levels in the two groups were similar on day 1 before surgery(P > 0.05). After surgery, the levelwas increased significantly and reached the highest value on day 3 after surgery. The plasma D-dimer in the control group returned to normal level on day14 after surgery,but it did not returned to normal in DVT group. Plasma D-dimer levels were significantly higher in DVT group than that in control group at different time points after surgery(P < 0. 05). The ROC curve for diagnosing DVT was made by the D-dimer level on day 3 after surgery, indicating that the diagnostic cut-off value was 4.25 mg/L FEU,and the area under ROC curve was 0. 94.95 % Cl was 0. 875-0.972. With plasma D-dimer level-4. 25 mg/L FEU as DVT( +) and < 4. 25 mg/L FEUas DVT(-), it was found that the sensitivity, specificity and accuracy of D-dimer in diagnosing DVT in bedridden patients after orthopedic surgery were 84.68%,92.26% and 94. 08%,respectively. Conclusion The plasma level of D-dimer significantly increases in patients after orthopedic surgery. Dynamic monitoring of D-dimer is of great significance for diagnosis and prediction of DVT in bedridden patients after surgery.
引文
[1]顾珊菱,赫子懿,林红,等.创伤骨科深静脉血栓筛查医护一体化模式的建立[J].中国老年学杂志,2017,37(15):3841-3843.
[2]吴昊,汪永新,李全才,等. D-二聚体动态监测对预测神经脊柱修复术后下肢深静脉血栓形成的意义[J].中国组织工程研究,2016,20(26):3863-3869.
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[6]韦微,杨星华,官正华,等.血液流变学及血浆D-9二聚体对骨科大手术后发生深静脉血栓的诊断价值[J].中华创伤杂志,2013,29(8):782-784.
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[8]李世飞,祝孟海,姚琦.D-二聚体及纤维蛋白原对老年髋部骨折患者围术期深静脉血栓形成的诊断价值[J].北京医学,2017,39(2):143-145.
[9]亓明,白云清.D-二聚体监测对老年长期卧床患者下肢深静脉血栓形成的早期诊断价值[J].中国老年学杂志,2013,33(17):4244-4245.
[10] HAN C, ZHAO Y, CHENG W, et al. The performance of ageadjusted D-dimer cut-off in Chinese outpatients with suspected venous thromboembolism[J]. ThrombRes,2015,136(4):739-743.
[11] MASUDA M,UETA T,SHIBA K,et al. D-dimer screening for deep venous thrombosis in traumatic cervical spinal injuries[J]. Spine J,2015,15(11):2338-2344.
[12]何娜,崔浩杰,彭永利,等.骨折患者围手术期动态监测血浆D-二聚体水平的临床意义[J].检验医学,2017,32(7):607-609.
[13]熊伟,吴九平,张郡,等.脊柱围手术期D-二聚体浓度变化规律以及与深静脉血栓形成的关系[J].中国实验诊断学,2017,21(1):113-114.
[14]杨志华,李青,冯健,等.脊柱退行性变患者围手术期D-二聚体的变化及其对深静脉血栓栓塞症的预测价值[J].中华全科医学,2017,15(4):583-585.
[15]吴为民,李杰,武梦华.D-二聚体在老年恶性肿瘤患者围术期下肢深静脉血栓形成预测中的价值[J].中国临床研究,2017,30(5):667-669.
[16]葛宗森.上肢骨骨折创伤患者血浆D-二聚体水平与深静脉栓塞发生率的相关性研究[J].标记免疫分析与临床,2016,23(6):648-650.
[2]吴昊,汪永新,李全才,等. D-二聚体动态监测对预测神经脊柱修复术后下肢深静脉血栓形成的意义[J].中国组织工程研究,2016,20(26):3863-3869.
[3] COLEMAN DM, OBI A, HENKE P K. Update in venous thromboembolism pathophysiology, diagnosis, and treatment for surgical patients[J]. CurrProblSurg,2015,52(6):233-259.
[4]何爽,张波,张明威.肿瘤患者手术治疗中D-二聚体动态监测的意义[J].标记免疫分析与临床,2017,24(1):16-18.
[5]邓长华.血浆D-二聚体对脊柱结核患者术后早期深静脉血栓形成的诊断价值[J].中国实验诊断学,2015,19(3):471-472.
[6]韦微,杨星华,官正华,等.血液流变学及血浆D-9二聚体对骨科大手术后发生深静脉血栓的诊断价值[J].中华创伤杂志,2013,29(8):782-784.
[7]杨军,董宝军,张福江,等.血栓弹力图、D-二聚体预测骨科大手术围手术期抗凝治疗终点并发DVT的诊断价值[J].中华骨科杂志,2015,35(8):801-807.
[8]李世飞,祝孟海,姚琦.D-二聚体及纤维蛋白原对老年髋部骨折患者围术期深静脉血栓形成的诊断价值[J].北京医学,2017,39(2):143-145.
[9]亓明,白云清.D-二聚体监测对老年长期卧床患者下肢深静脉血栓形成的早期诊断价值[J].中国老年学杂志,2013,33(17):4244-4245.
[10] HAN C, ZHAO Y, CHENG W, et al. The performance of ageadjusted D-dimer cut-off in Chinese outpatients with suspected venous thromboembolism[J]. ThrombRes,2015,136(4):739-743.
[11] MASUDA M,UETA T,SHIBA K,et al. D-dimer screening for deep venous thrombosis in traumatic cervical spinal injuries[J]. Spine J,2015,15(11):2338-2344.
[12]何娜,崔浩杰,彭永利,等.骨折患者围手术期动态监测血浆D-二聚体水平的临床意义[J].检验医学,2017,32(7):607-609.
[13]熊伟,吴九平,张郡,等.脊柱围手术期D-二聚体浓度变化规律以及与深静脉血栓形成的关系[J].中国实验诊断学,2017,21(1):113-114.
[14]杨志华,李青,冯健,等.脊柱退行性变患者围手术期D-二聚体的变化及其对深静脉血栓栓塞症的预测价值[J].中华全科医学,2017,15(4):583-585.
[15]吴为民,李杰,武梦华.D-二聚体在老年恶性肿瘤患者围术期下肢深静脉血栓形成预测中的价值[J].中国临床研究,2017,30(5):667-669.
[16]葛宗森.上肢骨骨折创伤患者血浆D-二聚体水平与深静脉栓塞发生率的相关性研究[J].标记免疫分析与临床,2016,23(6):648-650.