血浆D-二聚体在机械心脏瓣膜置换术后不同抗凝强度中的表达及临床意义

The expression and clinical significance of plasma D-dimer in patients after mechanical heart valve replacement

目的:了解D-二聚体检查在心脏瓣膜置换术后抗凝治疗中的地位和意义。方法:对行机械心脏瓣膜置换术后出院在2月以上的患者在门诊检查凝血四项(INR、Fbg、APTT、TT)及D-二聚体262例次,按照INR不同分为三组(I组:INR<1.5;II组:INR1.5～2.5;III组:INR>2.5),分析。结果:各组都有D-二聚体阳性的病例,但是发现大多数检验单集中在I及II组。在I组里的D-二聚体阳性和血栓发生率明显高于II组。I组和III组比较差异无统计学意义。II组和III组比较差异无统计学意义。在I组里出现2例脑栓塞和两例下肢血管栓塞患者;II组无栓塞患者;III组1例患者是在当地抗凝不足导致左下肢血管栓塞,加强抗凝及抗血栓治疗后,按INR的改变分到III组的。结论:D-二聚体在心脏瓣膜置换术后抗凝状态检查中占有很重要的地位,应该在心脏外科医生当中引起重视,特别是在前一次INR<1.5的患者中,应同时检查。在没有检查D-二聚体的情况下发现INR<1.5后应补充检查,以防止血栓的发生。

Objective ： To investigate the clinical significance of plasma D-dimer level in the anticoagulation therapy of patients after mechanical heart valve replacement.Methods： The data of blood clotting series（containing PTR,,INR,APTT,TT,Fbg）and plasma D-dimer level for patients undergone mechanical heart valve replacement for more than 2 months were collected,then the cases were divided into 3 groups according to their INR levels（GroupⅠ：INR1.5;GroupⅡ：INR 1.5-2.5;GroupⅢ：INR2.5）.Then analyzed the D-dimer level in each group.Results： There were D-dimer positive patients in each group,most of them came from GroupⅠand Ⅱ,the embolism complication incidence and D-dimer positive rate were notable highly in GroupⅠthan that in GroupⅡ.There was no statisticaly significant difference between Group I and Ⅲ,and no statisticaly significant difference between Group II and III.Four embolism patients（two in cerebrum,two in lower limb）were found in GroupⅠ,none in Group Ⅱ.One embolism patient was found in Group Ⅲ.Conclusions： The detection of plasma D-dimer have important guiding significance in the evaluation of the anticoagulation status,especially in patients whose INR data is lower than 1.5,those patients should pay more attention to avoid the occurence of embolism complication.