骨折患者血浆纤维蛋白原和D-二聚体联合检测的临床意义

DIAGNOSTIC VALUE OF PLASMA FIBRINOGEN AND D-DIMER ASSAY ON PATIENTS W ITH LOWER LIMB FRACTURE

目的探讨血浆纤维蛋白原(fibrinogen,FIB)及D-二聚体(D-dimer,DD)检测对下肢骨折并发深静脉血栓(deep vein thrombosis,DVT)的早期诊断价值。方法对下肢骨折患者178例术前及术后第3天和第7天进行血浆中FIB及DD定量检测,并与健康对照组(52例)比较。结果经静脉造影联合彩色多普勒检查,178例患者有26例并发DVT,其发生率为14.61%,其中24 h内发生DVT者占46.15%(12/26),3 d内发生DVT者占61.54%(16/26)。骨折组各时间点血浆FIB及DD均显著高于健康对照组(P<0.05);且术后3d及术后7d血浆FIB及DD显著高于术前,并呈进行性增高(P<0.05)。并发DVT组术后血浆FIB和DD显著高于术前,并呈进行性增高(P<0.05);未并发DVT组术后血浆FIB和DD略有升高,但与术前比较差异无统计学意义(P>0.05)。2组术前血浆FIB和DD差异无统计学意义(P>0.05);术后第3天和第7天血浆FIB和DD差异有统计学意义(P<0.05)。结论血浆FIB和DD的动态监测对骨折术后并发DVT具有早期诊断价值。

Objective To discuss the early diagnostic value of plasma fibrinogen（FIB） and Ddimer（DD） assay on patients with lower limb fracture and deep vein thrombosis （DVT）. Methods Plasma FIB and DD were quantitatively detected on 178 patients with lower limb fracture preoperatively, 3d and 7d postoperatively. The results were compared with control group. Results The occurrence rate of DVT was 14.61% （26/178） ,in which the rate of DVT was 46.15% （12/26） within 24 h,and the rate was 61.54% （ 16/26 ） within 3 d ; Preoperative and postoperative FIB and DD levels of limb fracture patients were significantly higher than those of control group （ P 〈 0. 05 ）. The levels of FIB and DD in postoperative 3d and 7d were significantly higher than those of preoperative （ P 〈 0. 05 ）, and increased grandually. The postoperative levels of FIB and DD were significantly higher than those of preoperative in DVT group （ P 〈 0. 05 ）, while in no DVT group the levels of FIB and DD only slightly increased postoperatively, and there was no significant difference before and after operation. The preoperative levels of FIB and DD had no significant difference between fracture group and control group, while there were significant differences in levels of FIB and DD between the two groups （ P 〈 0.05 ）. Conclusion Dynamic monitoring of FIB and DD is very useful for predicting occurrence of thromboembolism in lower limbs fracture.