脑梗死患者血容量不足与下肢深静脉血栓关系研究

Study on the connections between hypovolemia and lower extremity deep venous thrombosis in patients with cerebral infarction

目的探讨脑梗死患者血容量不足与下肢深静脉血栓（LDVT）的关系。方法选择脑梗死住院患者504例,通过血栓组与非血栓组的比较,制作尿素氮/肌酐比值、血浆渗透压、两者联合指标以及D-二聚体ROC曲线,计算上述指标临界值并比较敏感性、特异性。结果 ROC曲线结果分析显示：入院第10~14天尿素氮/肌酐比值诊断LDVT的ROC曲线下面积为0.788（95%CI：0.727~0.848）,最佳诊断切点为101.705,敏感性为58.0%,特异性为88.7%;血浆渗透压ROC曲线下面积为0.892（95%CI：0.836~0.949）,最佳诊断切点为305.77 mmol/L,敏感性为85.5%,特异性为90.8%;两者联合指标ROC曲线下面积为0.895（95%CI：0.837~0.952）;D-二聚体ROC曲线下面积为0.883（95%CI：0.832~0.935）,最佳诊断切点为3.055μg/L,敏感性为85.5%,特异性为82.1%。结论尿素氮/肌酐比值与血浆渗透压两者联合指标诊断LDVT优于D-二聚体,有利于LDVT早期诊断。

Objective To analyze and study the connections between hypovolemia and lower extremity deep venous thrombosis （LDVT）in patients with cerebral infarction. Methods A total of 504 hospitalized patients with cerebral in-farction were selected. According to the comparison between infarction group and non-infarction group, ROC curves of urea nitrogen/creatinine ratio, plasma osmotic pressure, combined index of the two indices above and D-dimer were created, cut-off value of the indices above was calculated, and sensitivity and specificity were compared. Results Analysis on the results of ROC curves showed ROC area under the curve of urea nitrogen/creatinine ratio in the diag-nosis of LDVT in 10-14 days after admission was 0.788（95%CI 0.727-0.848）,the optimal diagnostic cut-off point was 101.705, the sensitivity was 58%, and the specificity was 88.7%; ROC area under the curve of plasma osmotic pres-sure was 0.892 （95%CI 0.836-0.949）, the optimal diagnostic cut-off point was 305.77 mmol/L, the sensitivity was 85.5%, and the specificity was 90.8%; ROC area under the curve of the combined index was 0.895 （95%CI 0.837-0.952）; ROC area under the curve of D-dimer was 0.883（95%CI0.832-0.935）, the optimal diagnostic cut-off point was 3.055 ug/L,the sensitivity was 85.5%, and the specificity was 82.1%. Conclusion Combined index of urea nitro-gen/creatinine ratio and plasma osmotic pressure in the diagnosis of LVDT is better than D-dimer, which is beneficial for early diagnosis.