骨折患者血浆D-二聚体水平升高影响因素探讨

Discussion on influencing factors of increased plasma D-dimer level in patients with bone fracture

目的：探讨骨折患者血浆D-二聚体（D-dimer）升高及其影响因素。方法：采集235例骨折患者的血浆标本,在Sysmex CA-7000型全自动血凝仪上采用胶乳增强的免疫比浊法检测血浆D-dimer,并分析性别、年龄及病情严重程度与D-dimer之间的关系。结果：骨折患者组D-dimer增高与正常对照组比较差异有统计学意义（P〈0.05）。性别与D-dimer增高无关（P〉0.05）。年龄小于25岁的骨折患者血浆D-dimer增高与正常对照组比较差异无统计学意义（P〉0.05）;随着年龄的增加,D-dimer增高明显,特别是大于50岁的骨折患者其血浆Ddimer含量是对照组的8~10倍,差异有统计学意义（P〈0.05）。根据骨折部位、伤情分轻、中、重3度,单纯闭合性较轻微的骨折患者其D-dimer变化与健康对照组相比差异无统计学意义,随着骨折病情严重程度增加,血浆Ddimer增高较对照组差异有统计学意义（P〈0.05）,尤其是肢体2处及2处以上骨折伴有血管损伤或脏器损伤的严重骨折患者。结论：骨折患者应例行测定血浆D-dimer,对于年龄较大、病情比较严重的骨折患者应特别注意其血浆D-dimer的升高,及时抗凝,预防深静脉血栓形成。

Objective：To discuss the influencing factors of increased plasma D-dimer level in patients with bone fracture.Method：Plasma D-dimmer levels of 235 fracture patients were detected using latex enhanced immune turbidimetric method on Sysmex CA-7 000 type automatic blood coagulation analyzer,and the relationship between gender,age and disease severity and the D-dimer were analyzed.Result：Plasma D-dimer levels in fracture patients group were significantly higher than that in normal control group（P〈0.05）.Plasma D-dimer in age less than 25 years old fracture patients had no obviously difference compared with normal control group（P〉0.05）.Along with the increase of age,D-dimer significantly increased,especially in patients older than 50years（P〈0.05）.According to the fracture site,injury was classified into 3degrees,namely slight,medium and heavy.In simple closed slight fracture patients,the D-dimer change had no obvious difference compared with healthy controls.With the increase of fracture serious degree,plasma D-dimer was higher than control group（P〈0.05）,especially the patients with two and（or）more places fractures or fracture associated with vascular damage or serious fracture accompanied by visceral injury.Conclusion：Fracture patients should be routine measure plasma D-dimer.It should pay special attention to increased plasma D-dimer level of elder,serious fracture patients,so as to take timely anticoagulation and prevent deep vein thrombosis.