创伤患者深静脉血栓形成与D-Dimer的相关性

Incidence of deep venous thrombosis in trauma patients and its relation with plasma D-Dimer

目的分析创伤患者深静脉血栓形成(DVT)的发生率以及D-二聚体(D-Dimer)水平对DVT的诊断价值。方法选取单发股骨颈骨折、股骨转子间骨折、股骨干骨折、股骨髁间骨折予以静脉造影术检查的患者,以D-Dimer作为特异性纤溶过程标记物,采用胶体金免疫渗透试验定量检测,对D-Dimer浓度进行统计学分析。结果创伤患者DVT的发生率为11.4%。创伤患者DVT(+)组D-Dimer浓度高于DVT(-)组(P<0.05)。选取500μg/L作为正常参考值,其灵敏度为93.1%,特异度为63.6%,阳性预测值为24.8%,阴性预测值为98.6%。术前不同制动时间对D-Dimer浓度的影响差异有统计学意义(P<0.05)。结论 D-Dimer浓度正常对排除创伤患者DVT具有临床意义,D-Dimer浓度升高对诊断创伤患者DVT不具有临床意义。术前制动时间对D-Dimer浓度具有影响。

Objective To analyze the incidence of deep venous thrombosis（DVT） in trauma patients and its relation with plasma D-Dimer.Methods Patients with simply trauma,such as fracture of femoral neck,intertrochanteric fracture of femur,fracture of femoral shaft and condyloid fracture of femur were involved in this study and detected by using contrast venography.Plasma D-Dimer,a high specific fibrin degradation product,was measured by using NycoCard D-Dimer assay and was analyzed with statistic retrospectively.Results The incidence of DVT in trauma patients was 11.4%.Plasma D-Dimer level was significantly higher in patients with DVT than those without DVT（P〈0.05）.The sensitivity,specificity,positive predictive value and negative predictive value of 500 μg/L were 93.1%,63.6%,24.8% and 98.6%,respectively.Plasma D-Dimer level was affected by length of immobilization before operation.Conclusion Normal plasma D-Dimer concentration has clinic value of exclusion of DVT,while elevated plasma D-Dimer concentration has no value of diagnosis of DVT.Plasma D-Dimer level was affected by length of immobilization before operation.