摘要
目的分析D-二聚体(D-D)及纤维蛋白原(fibrinogen,FIB)对老年髋部骨折患者围术期深静脉血栓形成(DVT)的诊断价值。方法回顾性分析2015年1月至2016年6月我科老年髋部骨折后手术治疗患者169例(年龄>60岁),根据彩色多普勒超声将患者分为无血栓组157例(男43例、女114例,平均年龄78岁)和血栓组12例(男4例、女8例,平均年龄76岁)。记录患者性别、年龄、术前制动时间、手术时间、基础疾病,术前、术后1~5 d、术后6~10 d的血浆D-D值及FIB值。应用SPSS 20.0统计软件,绘制ROC曲线,进行统计学分析。结果 2组患者性别、年龄、术前制动时间、术前和术后6~10 d D-D和FIB值的差异均无统计学意义(P>0.05);2组基础疾病、术后1~5 d D-D和FIB值的差异有统计学意义(P<0.05)。根据ROC曲线,单独检测D-D和FIB时,术后1~5 d的D-D值和FIB曲线下最大面积分别为0.801和0.746,位于ROC曲线左上角的值为截断值,血浆D-D>1 587μg/L和FIB>4.69 g/L,D-D和FIB联合检测时ROC曲线下面积为0.835,联合检测时的敏感性和准确度较单独诊断时高。结论根据ROC曲线,髋部骨折术后1~5 d,D-D>1 587μg/L和FIB>4.69 g/L的患者发生DVT的风险较大,应尽早进行相关检查,积极预防和治疗。
Objective To investigate the diagnostic value of D-dimer and FIB in perioperative deep venous thrombosis of elderly hip fracture patients. Methods One hundred and sixty-nine patients who underwent hip surgery and older than 60 years old were collected from January 2015 to June 2016. According to the color doppler ultrasonography, patients were divided into no thrombus group in which 157 patients （43 males and 114 females） with the median age 78 years old and thrombus group including 12 patients （4 males and 8 females） with the median age 76 years old. Logistic regression was used to identify the association of DVT and the variables including gender, age, preoperative braking time, duration of surgery and chronic illness. The D-dimer and FIB levels were measured in patients pre-operatively and postoperatively at day 1 to 5 and day 6 to 10. SPSS 20.0 software was applied to make ROC curve for statistical analysis. Results There was no statistically significant difference in gender, age, preoperative braking time, duration of surgery and plasma levels of D-dimer and FIB pre-operative and postoperative at day 6 to 10 between the two groups. The postoperative plasma levels of D-dimer and FIB on day 1 to 5 were significantly different between the two groups. By the ROC curve, the curve of the postoperative D-dimer and FIB showed largest AUC 0.801 and 0.746 on day 1 to 5. The cut-off value was located at the left upper comer of the ROC curve, which indicated that the plasma D-dimer and FIB exceeded 1 587 μg/L and FIB 〉4.69 g/L, the curve of combined detection＇s AUC was 0.835, the sensitivity and accuracy were higher than each alone. Conclusion According the ROC curve, elderly patients with plasma D-dimer more than 1 587μg/L and FIB more than 4.69 g/L postoperatively on day 1 to 5 show a higher risk of DVT. Early related examination and prophylaxis is necessary.
出处
《北京医学》
CAS
2017年第2期143-145,149,共4页
Beijing Medical Journal
基金
北京市科委课题(Z151100003915094)
中国医师协会课题(2015-A35)
