急慢性期下肢深静脉血栓MSCT征象与凝血纤溶指标相关性探讨

A Correlative Study of MSCT Presentation and Coagulate and Fibrinolvsis Index in Acute and Chronic Deep Venous Thrombosis of Lower Limb

目的探讨急慢性期下肢深静脉血栓形成(DVT)的多层螺旋CT(MSCT)征象与凝血纤溶指标凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)之间的相关性。资料与方法回顾性分析37例DVT患者资料,根据病程将DVT分为急慢性期,观察MSCT增强图像上血栓及软组织表现,测量平扫时轴位图像上血栓CT值。根据MSCT上血栓形态、血栓分布范围、CT值分组,分析MSCT征象与PT、APTT、FIB、TT的相关性。结果根据病程分组,急性期DVT 18例,MSCT主要表现为管腔中央充盈缺损,管腔扩大,血栓呈连续性分布,软组织肿胀;慢性期DVT 19例,MSCT主要表现为管腔内偏心性充盈缺损,血栓分布呈节段性,侧支循环增多、浅静脉迂曲;平扫时急慢性期血栓CT值平均数分别为(59.26±11.89)HU和(37.42±9.46)HU,U=20.92,P<0.05,差异有统计学意义。MSCT上,血栓形态为中心性充盈缺损组PT、APTT、FIB值均较偏心性充盈缺损组高,t值分别为4.95、3.27、4.05,P<0.05;血栓呈连续性分布组PT值较节段性分布组高,t=6.10,P<0.05;血栓CT值≥53.6 HU组PT、APTT、FIB值均较CT值<53.6 HU者高,t分别为3.97、6.21、6.14,P<0.05,差异存在统计学意义。结论急慢性期DVT的MSCT表现与PT、APTT、FIB存在一定相关性,TT未见明显相关性,结合两者检查,可提高血栓急慢性期判断的准确性,为临床治疗方案的制定提供可靠依据。

Objective To investigate the correlation between MSCT presentation and PT,APTT,FIB and TT in acute and chronic deep venous thrombosis（DVT）of lower limb.Materials and Methods The MSCT data of 37 patients with DVT were retrospectively studied.Firstly,these cases were grouped into acute and chronic period according to course of disease.The appearance of thrombus and soft tissue were reviewed in enhanced CT.The CT value was measured in non-enhanced CT.Then these cases were grouped again according to the form,distribution and CT value of thrombus in MSCT.The relationship between MSCT signs and PT,APTT,FIB and TT was analysed.Results 18 patients with acute DVT showed central filling defect in dilated veins,usually successive distributed,and the soft tissue were swelling significantly.19 patients with chronic DVT showed eccentric filling defect,usually segmental distributed.Lateral branches and superficial veins got more and circuitous.The average CT value of acute and chronic DVT were（59.26±11.89） HU and（37.42±9.46） HU,U=20.92,P0.05.Compared group central filling defect and eccentric filling defect,PT,APTT and FIB of the former were higher.The t value were 4.95,3.27 and 4.05 respectively,P0.05.Compared group successive distribution and segmental distribution,PT of the former one was higher（t=6.10,P0.05）.Compared group CT value ≥53.6 HU and CT value 53.6 HU,PT,APTT and FIB of the former were higher.The t value were 3.97,6.21 and 6.14 respectively,P0.05.All differences had statistical significance.Conclusion MSCT signs of acute and chronic DVT of lower limb has some correlation to PT,APTT and FIB except TT.Combining MSCT with coagulation and fibrinolvsis examination could improve the accuracy of the diagnose of acute and chronic DVT.