下肢静脉血栓患者D-二聚体联合股动脉彩超检测对治疗和预后的指导意义
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摘要
目的探讨D-二聚体与股动脉彩色多普勒超声联合检测对下肢静脉血栓患者的治疗和预后的指导意义。方法选择下肢静脉血栓患者170例,对其进行D-二聚体及股动脉彩色多普勒超声检测。将血浆D-二聚体浓度大于或等于1 000μg/L判定为阳性患者,对彩色多普勒超声检测结果为阴性但血浆D-二聚体测定为阳性的患者进行二次彩色多普勒超声检测;对全部患者进行下肢静脉造影检测。结果合并肺栓塞组患者D-二聚体含量显著高于无肺栓塞组(P<0.05);混合型下肢静脉血栓患者的D-二聚体阳性率及溶栓前后D-二聚体含量均显著高于周围型、中央型患者(P<0.05);通过将彩色多普勒超声与血浆D-二聚体浓度两种检测方法相结合,中央型、周围型及混合型下肢静脉血栓患者检测的灵敏度均大大增加。结论 D-二聚体的联合股动脉彩超检测增加了下肢静脉血栓的特异性以及灵敏度,对于下肢静脉血栓患者的治疗和预后具有指导意义。
Objective To investigate the directive significance of combination detection of D-dimer and femoral artery color dopplar ultrasound in treatment and prognossis evaluation of patients with lower limb venous thrombosis. Methods One hundred and seventy patients with lower limb venous thrombosis who were treated in our hospital were enrolled in the study.These patients were examined by D-dimer combined with femoral artery color Dopplar ultrasound. The patients with the concentration of plasma D-dimer > 1,000μg/L were regarded as positive patients. The patients whose examination results of color Doppler ultrasound were negative and the detection results of D dimer were positive should have a second detection. All the patients received lower limb venography detection. Results The levels of D-dimer in patients with lower limb venous thrombosis complicated by pulmonary embolism were significantly higher than those of patients with simple lower limb venous thrombosis( P < 0. 05). The positive rate of D dimer and D-dimer levels before and after thrombolysis in patients with mixed type lower limb venous thrombosis were significantly higher than those of patients with peripheral and central type lower limb venous thrombosis( P < 0. 05). The combination detection of color Dopplar ultrasound and plasma levels of D-dimer could increase the sensitivity of detecting the central type,peripheral type and mixed type lower limb venous thrombosis. Conclusion The combination detection of color Dopplar ultrasound and plasma levels of D-dimer can increase the specificity and sensitivity of detection of lower limb venous thrombosis,which has directive significance in the treatment and prognosis evaluation of patients with lower limb venous thrombosis.
Objective To investigate the directive significance of combination detection of D-dimer and femoral artery color dopplar ultrasound in treatment and prognossis evaluation of patients with lower limb venous thrombosis. Methods One hundred and seventy patients with lower limb venous thrombosis who were treated in our hospital were enrolled in the study.These patients were examined by D-dimer combined with femoral artery color Dopplar ultrasound. The patients with the concentration of plasma D-dimer > 1,000μg/L were regarded as positive patients. The patients whose examination results of color Doppler ultrasound were negative and the detection results of D dimer were positive should have a second detection. All the patients received lower limb venography detection. Results The levels of D-dimer in patients with lower limb venous thrombosis complicated by pulmonary embolism were significantly higher than those of patients with simple lower limb venous thrombosis( P < 0. 05). The positive rate of D dimer and D-dimer levels before and after thrombolysis in patients with mixed type lower limb venous thrombosis were significantly higher than those of patients with peripheral and central type lower limb venous thrombosis( P < 0. 05). The combination detection of color Dopplar ultrasound and plasma levels of D-dimer could increase the sensitivity of detecting the central type,peripheral type and mixed type lower limb venous thrombosis. Conclusion The combination detection of color Dopplar ultrasound and plasma levels of D-dimer can increase the specificity and sensitivity of detection of lower limb venous thrombosis,which has directive significance in the treatment and prognosis evaluation of patients with lower limb venous thrombosis.
引文
1倪伟.骨科手术后深静脉血栓形成的预防研究及护理.中国社区医师,2015,31:127-128.
2 陆燕,蔡攀,汤明荣,等.高龄髋部骨折患者围术期D-二聚体的测定及临床意义.国际检验医学杂志,2015,36:25-26.
3 刘华磊,王淑霞.下肢动静脉血栓30例超声诊断分析.河南外科学杂志,2015,21:130-131.
4 司文腾,张华果,孙宜保,等.脊柱术后血浆D-二聚体浓度变化与深静脉血栓的关系研究.中国骨伤,2014,27:405-408.
5 赵玉芬,段小凯.D-二聚体定量检测在外科患者手术后病情监测中的应用.河南外科学杂志,2013,19:50-54.
6 陶方,季红莉,李中侠,等.高龄住院患者下肢深静脉血栓形成的临床分析及护理.河北医药,2015,37:2385-2387.
7 侯伟,熊小明,万趸.骨盆骨折内固定术中应用普通肝素对术后下肢深静脉血栓发生率的影响.四川医学,2015,36:996-999.
8 腾飞,何新华,杨杰,等.Wells评分联合D-dimer在急性肺栓塞诊断的临床预测价值.中华急诊医学杂志,2015,24:422-425.
9 余美琴,李俊来,曹晓林,等.老年下肢深静脉血栓患者D-二聚体的临界值研究.中华老年心脑血管病杂志,2013,15:32-34.
10 陈霞,张晟.血浆D-二聚体浓度筛查辅助超声联合检测髋部骨折患者下肢深静脉血栓的价值.广东医学,2011,32:3080-3082.
11 沈明荃,谢增如.复合骨折后下肢深静脉血栓形成Wells评分与D-二聚体及纤维蛋白降解产物的预测.中国组织工程研究,2014,18:6136-6140.
12 张纪媛,郭丹青,何惠.下肢深静脉血栓患者外周血血小板p-选择素、D二聚体及超敏C反应蛋白的表达及临床意义.中国医药导报,2014,11:34-36.
13 殷明春.D-二聚体在老年下肢深静脉血栓预测中的临界值探讨.中国医药导刊,2014,11:313-314.
14 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.中国老年学杂志,2013,33:4244-4245.
15 欧永强.D-二聚体、同型半胱氨酸、超敏C反应蛋白对深静脉血栓性疾病早期诊断及预后的价值.中国老年学杂志,2012,32:2290-2291.
16 张辉良,梁俊生,张洪斌,等.利伐沙班与华法林治疗老年髋部骨折术前并存下肢深静脉血栓比较研究.长春中医药大学学报,2013,29:323-324.
17 王国杰,张灼锦.血浆D-二聚体检测对下肢深静脉血栓的早期诊断价值.实用医学杂志,2012,28:2368-2370.
18 张立涛,张静梅,梁俊生,等.老年人骨折后早期下肢深静脉血栓形成情况分析.中国骨质疏松杂志,2013,19:43-45,82.
2 陆燕,蔡攀,汤明荣,等.高龄髋部骨折患者围术期D-二聚体的测定及临床意义.国际检验医学杂志,2015,36:25-26.
3 刘华磊,王淑霞.下肢动静脉血栓30例超声诊断分析.河南外科学杂志,2015,21:130-131.
4 司文腾,张华果,孙宜保,等.脊柱术后血浆D-二聚体浓度变化与深静脉血栓的关系研究.中国骨伤,2014,27:405-408.
5 赵玉芬,段小凯.D-二聚体定量检测在外科患者手术后病情监测中的应用.河南外科学杂志,2013,19:50-54.
6 陶方,季红莉,李中侠,等.高龄住院患者下肢深静脉血栓形成的临床分析及护理.河北医药,2015,37:2385-2387.
7 侯伟,熊小明,万趸.骨盆骨折内固定术中应用普通肝素对术后下肢深静脉血栓发生率的影响.四川医学,2015,36:996-999.
8 腾飞,何新华,杨杰,等.Wells评分联合D-dimer在急性肺栓塞诊断的临床预测价值.中华急诊医学杂志,2015,24:422-425.
9 余美琴,李俊来,曹晓林,等.老年下肢深静脉血栓患者D-二聚体的临界值研究.中华老年心脑血管病杂志,2013,15:32-34.
10 陈霞,张晟.血浆D-二聚体浓度筛查辅助超声联合检测髋部骨折患者下肢深静脉血栓的价值.广东医学,2011,32:3080-3082.
11 沈明荃,谢增如.复合骨折后下肢深静脉血栓形成Wells评分与D-二聚体及纤维蛋白降解产物的预测.中国组织工程研究,2014,18:6136-6140.
12 张纪媛,郭丹青,何惠.下肢深静脉血栓患者外周血血小板p-选择素、D二聚体及超敏C反应蛋白的表达及临床意义.中国医药导报,2014,11:34-36.
13 殷明春.D-二聚体在老年下肢深静脉血栓预测中的临界值探讨.中国医药导刊,2014,11:313-314.
14 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.中国老年学杂志,2013,33:4244-4245.
15 欧永强.D-二聚体、同型半胱氨酸、超敏C反应蛋白对深静脉血栓性疾病早期诊断及预后的价值.中国老年学杂志,2012,32:2290-2291.
16 张辉良,梁俊生,张洪斌,等.利伐沙班与华法林治疗老年髋部骨折术前并存下肢深静脉血栓比较研究.长春中医药大学学报,2013,29:323-324.
17 王国杰,张灼锦.血浆D-二聚体检测对下肢深静脉血栓的早期诊断价值.实用医学杂志,2012,28:2368-2370.
18 张立涛,张静梅,梁俊生,等.老年人骨折后早期下肢深静脉血栓形成情况分析.中国骨质疏松杂志,2013,19:43-45,82.