摘要
目的 探讨急诊血液化验及肠壁厚度测量对肠系膜上静脉血栓致肠坏死的早期诊断价值.方法 回顾性分析2006年4月至2013年6月19例肠系膜上静脉血栓患者的临床资料,分为肠坏死组10例,肠淤血组9例.比较2组白细胞总数、中性粒细胞比例、红细胞计数、血小板计数、肌酸激酶（creatine kinase,CK）、肌酸激酶同工酶（MB isoenzyme of creatine kinase,CK-MB）、国际标准化比值（international normalized ratio,INR）、纤维蛋白原及D二聚体,测量2组CT横断面肠壁最厚处的厚度.结果 肠坏死组血浆D二聚体（3.27 ～ 20.00） μg/ml,中位值（19.85） μg/ml,肠淤血组血浆D二聚体（0.49～ 13.90） μg/ml,中位值（5.55） μg/ml,两者比较差异有统计学意义（P＜0.05）.以D二聚体＞ 10 μg/ml为截点,对诊断肠系膜上静脉血栓致肠坏死的灵敏度、特异度、阳性预测值及阴性预测值分别为：70％,89％,87.5％,73％.肠坏死组肠壁厚度为（8.35～15.45） mm,中位值（10.48） mm,肠淤血组肠壁厚度为（1.29～8.70） mm,中位值（1.43） mm,两者比较差异有统计学意义（P＜0.05）.以小肠壁厚度＞8 mm为截点,对诊断肠系膜上静脉血栓致肠坏死的灵敏度、特异度、阳性预测值及阴性预测值分别为：100％,89％,90.9％,100％.结论 D二聚体浓度及肠壁厚度对肠系膜上静脉血栓致肠坏死具有重要预测价值.
Objective To evaluate emergency blood test and bowel wall thickness measurement in predicting intestinal infarction caused by acute superior mesenteric vein thrombosis （SMV）.Methods 19 SMV patients were divided into two groups：necrotic bowel group （NB,n =10） and congested bowel group （CB,n =9）.White blood cell,neutrophil ratio,red blood cell,platelet,creatine kinase （CK）,MB isoenzyme of creatine kinase （CK-MB）,international normalized ratio （INR）,fibrinogen and D-dimer were compared between the two groups.The bowel wall thickness measured by CT scan were compared between the two groups.Results The levels of D-dimer in NB and CB were 19.85 （3.27-20.00） μg/ml,5.55（0.49-13.90） μg/ml,respectively （P ＜ 0.05）.Sensitivity,specificity,positive predictive value,negative predictive value of the D-dimer ＞ 10 μg/mnl in diagnosing intestinal infarction were 70％,89％,87.5％,73％.The bowel wall thickness in NB and CB were 10.48 （8.35-15.45） mm,1.43 （1.29-8.70） mm,respectively （P ＜ 0.05）.Sensitivity,specificity,positive predictive value,negative predictive value of the bowel wall thickness ＞ 8 mm in diagnosing intestinal infarction were 100％,89％,90.9％,100％.Conclusions D-dimer and bowel wall thickness were able to predict for intestinal infarction caused by SMV.
出处
《中华普通外科杂志》
CSCD
北大核心
2014年第12期923-926,共4页
Chinese Journal of General Surgery
