D-二聚体对门静脉高压症术后门静脉血栓形成的早期预测价值

D-dimer:a early predictor of portal vein thrombosis after portal hypertension operation

目的评价D-二聚体对乙肝肝硬化门静脉高压症术后门静脉血栓形成(PVT)的早期预测价值。方法用快速、半定量检测方法动态检测门静脉高压症围手术期D-二聚体浓度,同时于术前及术后7～14 d内检查彩色多谱勒以观察PVT的发生情况。据不同诊断标准,计算灵敏度、特异度、阳性预测价值、阴性预测价值并进行ROC分析。结果乙肝肝硬化门静脉高压症手术后发生PVT的血栓组D-二聚体水平明显高于非血栓组(P＜0．01),ROC分析半定量D-二聚体标准及D-二聚体的定性标准对PVT均具有中等预测价值(半定量A_2=0．794；P＜0．01；定性标准：A_2=0．739；P＜0．01)。结论门静脉高压症术后动态检测D-二聚体水平将有助于PVT的早期诊断,如手术3 d后D-二聚体水平持续升高者及手术3 d后D-二聚体≥16 mg/L,PVT发生的可能较大,应加强抗凝等预防和治疗。

Objective To evaluate the predictive value of D-dimer for portal vein thrombosis （PVT） after hepatitis B cirrhosis-related portal hypertension operation. Methods The levels of D-dimer were detected by using a rapid semiquantitative D-dimer assays peri-operatively in the patients with portal hypertension, at the same time, ultrasonography was performed pre- and 7-14 days post-operation. Sensitivity,specificity,positive predictive value and negative predictive value was calculated at different cutoff value, and additional receiver-operated characteristics （ROC） analysis was performed. Results The level of D-dimer was higher in patients with PVT postoperation than that in patients without PVT （P〈 0.01） .Both semiquantitative D-dimer standard and qualitative standard based D-dimer had middle predictive value （semiquantitative standard： Az = 0. 794 ; P 〈 0.01 ; qualitative standard ： Az = 0. 739 ; P 〈 0.01 ）. Conclusion Detecting D-dimer dynamically would be helpful to early diagnosis of PVT after por- tal hypertension operation, and a persistence increased D-dimer or the figure of D-dimer more than 16 mg/L on the 3rd day postoperation means that the incidence of PVT may be higher, and anticoagulant therapy should be taken.