摘要
目的 探讨静脉双功超声(DUS)联合红细胞分布宽度(RDW)、血小板与淋巴细胞比值(PLR)对烧伤患者静脉血栓栓塞症(VTE)发生风险的预测价值。方法 回顾性分析2020年4月至2023年4月金华市中心医院收治的烧伤患者126例,治疗后常规随访6个月,以静脉血管造影为金标准分为VTE组25例和无VTE组101例。治疗前采用DUS检测下肢深静脉的管腔直径和峰值流速,由经验丰富的超声科医师进行血栓定性诊断;检测患者血生化指标包括RBC、RDW、PLT、PLR以及凝血功能指标。比较两组患者的临床资料、治疗前的超声参数和血生化指标;分析患者下肢深静脉峰值流速与RDW、D-二聚体、Fib、PLR及血栓风险评估表(Caprini评分)的相关性;以静脉血管造影结果为金标准,分析DUS血栓定性诊断的价值;分析下肢深静脉峰值流速、RDW和PLR对VTE的诊断效能。结果 与无VTE组比较,VTE组患者年龄和烧伤面积占体表总面积百分比增加,管腔直径、RDW、D-二聚体和Fib水平均增加(均P<0.05),而峰值流速和PLR降低(均P<0.05)。峰值流速与RDW、D-二聚体和Fib水平均呈负相关(均P<0.05),与PLR呈正相关(P<0.05)。DUS血栓定性诊断的准确度为0.889,灵敏度为0.800,特异度为0.911,阳性预测值为0.690,阴性预测值为0.948。ROC曲线分析显示,峰值流速、RDW和PLR诊断VTE的AUC分别为0.723、0.698和0.623,峰值流速联合RDW诊断VTE的AUC为0.797,高于单一指标(均P<0.05)。结论 DUS或可作为临床筛查和诊断VTE的首选无创工具,峰值流速联合RDW能够提供更多VTE的血流信息,能够更好地预测烧伤患者VTE的发生风险。
Objective To investigate the risk of venous thromboembolism(VTE) of burn patients predicted by venous duplex ultrasonography(DUS) combined with red blood cell distribution width(RDW) and platelets to lymphocytes ratio(PLR).Methods A retrospective summary was conducted on 126 burn patients diagnosed in Jinhua Municipal Central Hospital from April 2020 to April 2023.They were routinely followed up for 6 months after treatment and were divided into VTE group of 25 cases and non-VTE group of 101 cases according to venous angiography as the gold standard.Before treatment,DUS was used to measure lumen diameter and peak flow velocity of the deep veins in the lower limbs,and experienced ultrasound physicians made the qualitative diagnosis of thrombosis.Blood biochemistry including red blood cell count,RDW,platelet count,PLR,and coagulation function were detected.The clinical data,and ultrasound parameters and blood biochemical indicators before treatment were compared between the two groups.The study explored the correlation between peak velocity of deep vein of lower limbs and RDW,D-dimer,fibrinogen(Fib),PLR and the thrombus risk assessment scale(Caprini score).With venous angiography as the gold standard,the value of DUS in qualitative diagnosis of thrombus was analyzed.The values of peak velocity of deep veins of lower limbs,RDW and PLR in VTE diagnosis were also analyzed.Results Compared with the non-VTE group,patients' age and percentage of burn area in total body surface area(TBSA%) were larger in VTE group,and lumen diameter,RDW,D-dimer,and fibrinogen(Fib) levels were significantly higher(all P<0.05),while peak flow velocity and PLR were significantly less(both P<0.05).Spearman test showed that peak flow velocity was negatively correlated with RDW,D-dimer,and Fib,while positively correlated with PLR(P<0.05 for all).The accuracy,sensitivity and specificity of DUS in qualitative diagnosis of thrombosis were 0.889,0.800,0.911,respectively,while the positive and negative predictive values were 0.690,0.948,respectively.The area under curve(AUC) of peak flow velocity,RDW and PLR for predicting VTE using receiver operating curve(ROC) were 0.723,0.698 and 0.623,respectively,and the AUC of peak flow velocity combined with RDW for VTE diagnosis was 0.797,significantly higher than single indicator(all P<0.05).Conclusion DUS as the preferred non-invasive tool for clinical screening and diagnosis of VTE can provide more blood flow information for VTE by combining quantitative parameters such as peak flow velocity and RDW,which could better predict the occurrence of venous thrombosis in burn patients.
作者
马继中
王野平
孔敏刚
李杨
MA Jizhong;WANG Yeping;KONG Mingang;LI Yang(Department of Burn and Plastic Surgery,Jinhua Municipal Central Hospital,Jinhua 321000,China;不详)
出处
《浙江医学》
CAS
2024年第5期490-495,共6页
Zhejiang Medical Journal
基金
金华市科技计划项目(2021-3-103)。
关键词
静脉双功超声
红细胞分布宽度
血小板与淋巴细胞比值
烧伤
静脉血栓栓塞症
Venous duplex ultrasonography
Red blood cell distribution width
Platelets to lymphocytes ratio
Burn
Venous thromboembolism
