不同D-二聚体阈值筛查创伤骨科患者下肢深静脉血栓的研究

Study on the Screening of Lower Extremity DVT by Different D-Dimer Values Among Orthopedic Trauma Patients

目的评价D-二聚体不同阈值筛查创伤骨科患者下肢深静脉血栓(DVT)的优劣性,分析创伤骨科患者下肢血栓的常见类型。方法回顾性分析我科2020年6月-2021年6月新鲜骨折住院患者的检查检验结果。依据患者双下肢血管超声结果明确有无血栓并分组,对比分析不同D-二聚体阈值筛查创伤骨科患者下肢DVT的优劣性。分析创伤骨科患者下肢血栓的常见类型。结果共纳入97例研究对象,血栓组与非血栓组的D-二聚体值有显著性差异。利用ROC曲线对患者D-二聚体值进行分析,该方法敏感性为85.7%,特异性为33.8%,ROC曲线下面积0.826。根据约登指数定义,最佳诊断值为1.1μg/mL,也就是将原有阈值提高,该新阈值敏感性为61.9%,特异性为74.6%。血栓类型方面,小腿肌间静脉血栓占下肢血栓的77.0%。结论新的D-二聚体筛查阈值能有效提高该检测方法特异性,减少不必要的进一步检查。创伤骨科患者下肢血栓通常以小腿肌间静脉血栓为主。

Objective To evaluate the clinical value of D-dimer for screening the lower extremity deep venous thrombosis(DVT)among orthopedic trauma patients.Methods The test and examination report were collected from our department from Jun,2020 to Jun,2021;And the dates were analyzed retrospectively.Regarding thevenous ultrasonography examination as the“golden standard”to determine the existence of lower extremity DVT,the sensibility and specificity of plasm D-dimer for screening the lower extremity DVT were analyzed and evaluated.Results 97 patients were enrolled into the study.There were significant differences in D-dimer levels between two groups(P<0.01).The sensitivity,specificity and AUC of D-dimer in screening lower extremity DVT were 85.7%,33.8%,0.826,respectively.ROC curve was used to analyze the patient’s D-dimer levels and the optimal diagnostic value was decided by Youden’s index,which was 1.1μg/mL.The sensitivity and specificity of this method were were 61.9%and 74.6%。In terms of the type of thrombosis,intermuscular venous thrombosis of the calf accounted for 77.0%of lower limb thrombosis.Conclusion The new d-dimer threshold can effectively improve the specificity of the test and reduce unnecessary further tests.among orthopedic trauma patients,the main thrombosis of lower extremity is usually intermuscular vein thrombosis of calf.