中老年外伤性人工髋关节置换术后深静脉血栓的早期实验诊断研究

Early experimental diagnosis for deep vein thrombosis after traumatic hip arthroplasty in old and middle-aged patients

目的探讨中老年外伤性人工髋关节置换术后并发下肢深静脉血栓(deep vein thrombosis,DVT)早期诊断的血液学指标,对其早期诊断的临床价值。方法选取华北理工大学附属骨科医院自2010年1月至2015年2月,中老年外伤性人工髋关节置换术后并发下肢深静脉血栓形成150例为病例组,选取同期没有下肢深静脉血栓形成的150例为对照组。采集空腹静脉血分别采用放射免疫分析法检测125I纤维蛋白原(iodine 125 labeled focused ion beam,125IFIB)和自动血凝仪检测D-二聚体(D-dimer,DD),酶联免疫吸附法检测血浆进行血浆纤维蛋白原(focused ion beam,FIB)、D-二聚体、抗凝血酶Ⅲ(antithrombinⅢ,AT-Ⅲ)、血栓前体蛋白(thrombus precursor protein,Tp P)、凝血酶-抗凝血酶复合物(thrombin antithrombin complexes,TAT)检测。结果术后血浆中的125I纤维蛋白原和D-二聚体检测结果表明,血栓组明显升高,血浆中的125I纤维蛋白原和D-二聚体术后值明显高于术前值(P<0.05)。在用ELISA方法检测的指标中血浆纤维蛋白原、D-二聚体、血栓前体蛋白、凝血酶-抗凝血酶复合物和抗凝血酶Ⅲ的曲线下面积分别为88.1%、86.4%、67.4%、70.0%和64.1%。Logistic回归分析结果表明,纤维蛋白原和D-二聚体OR值分别为13.294和7.784(P<0.05)。结论血浆纤维蛋白原和D-二聚体在对人工髋关节置换术后并发深静脉血栓患者早期诊断中价值较高。

Objective To investigate the clinical value by detecting hematology index in the early experimental diagnosis of deep vein thrombosis after traumatic hip arthroplasty in old and middle-aged patients. Methods Totally 150 cases of traumatic hip arthroplasty combined with deep vein thrombosis in lower limb were selected as a study group（ thrombus group） while 150 cases without deep vein thrombosis in lower limb were chosen as a control group. All those patients are from Tangshan Orthopedics Hospital during January 2011 to February 2015. To conduct125 IFIB and DD detection of collected fasting venous blood by radioimmunoassay and to detect FIB,DD,AT-Ⅲ,Tp P,TAT of plasma by ELISA. Results Postoperative125 IFIB and DD of plasma testing results show that 125 IFIB and DD in plasma in thrombus group increased significantly,which is obviously higher than preoperative value,as it is statistically significant.（ P 〈 0. 05）On the other hand,the results from ELISA show that the area under the curve of FIB,DD,Tp P,TAT and AT-Ⅲ are respectively88. 1%,86. 4%,P 〈 0. 01; 67. 4%,70. 0%,P 〈 0. 05 and 64. 1%,P 〉 0. 05. The results of Logistic regression analysis showed that the OR values of fibrinogen and D-two were 13. 294 and 7. 784 respectively（ P 〈 0. 05）. Conclusion fibrinogen and D-dimer in plasma have certain clinical significance in the early diagnosis of deep vein thrombosis patients after hip arthroplasty.