创伤患者血浆D-二聚体、纤维蛋白原与骨折部位及创伤程度的相关性研究

Correlation Study between plasma D-dimer、Fibrinogen Levels and Fracture Site、Orthopedic Trauma Severity

目的通过分析骨折患者与正常体检者的血浆D-二聚体和纤维蛋白原水平,研究其与骨折部位及创伤程度的相关性。方法选取2014年7月至2015年7月因骨折至我院骨科入住的患者230例(创伤组)及同期正常体检者100例(对照组),将创伤组患者根据不同骨折部位分为7组:肱骨骨折(32例)、尺桡骨骨折(32例)、股骨骨折(35例)、胫腓骨骨折(33例)、足骨骨折(31例)、脊柱骨折(32例)、多发性骨折(35例),同时依据损伤严重程度(injury severity score,ISS)评分划分为轻度创伤组(113例),中度创伤组(47例)和重度创伤组(70例)。测定创伤组患者的血浆D-二聚体及纤维蛋白原浓度,与对照组进行比较,并就不同骨折部位及不同创伤程度的D-二聚体及纤维蛋白原浓度进行统计学分析。结果创伤组患者血浆D-二聚体及纤维蛋白原水平明显高于对照组,差异有统计学意义(P<0.01)。不同骨折部位患者血浆D-二聚体水平有显著差异(H=104.27,P<0.01),由高到低依次为多发伤、脊柱、股骨、胫腓骨、足骨、肱骨和尺桡骨;不同骨折部位患者血浆纤维蛋白原浓度差异有统计学意义(H=62.84,P<0.01),由高到低依次为多发伤、脊柱、股骨、足骨、胫腓骨、肱骨和尺桡骨。创伤程度越重,患者的血浆D-二聚体及纤维蛋白原越高,各创伤程度组间差异均存在统计学意义(P<0.01)。结论骨折患者的血浆D-二聚体和纤维蛋白原水平明显高于正常人,与骨折部位有密切相关性,且会随创伤程度的加重而逐渐升高,因此骨折患者的血浆D-二聚体及纤维蛋白原监测对其早期病情判断有重要价值。

Objective To study the association of D-dimer,fibrinogen levels with fracture site and trauma severity by analyzing their values in orthopedic trauma patients and healthy physical examinees. Methods We enrolled 230 patients with closed fracture who were admitted into the Affiliated Drum Tower Hospital of Nanjing University Medical School from July 2014 to July 2015. Based on their locations of fracture,the patients were divided into seven groups： humeral fracture（ 32）,ulna and radius fracture（ 32）,femoral fracture（ 35）,tibia and fibula fracture（ 33）,foot fracture（ 31）,spine fracture（ 32） and multiple fractures（ 35）. Another 100 healthy people who received outpatient service were also involved as control group. The patients were then divided into mild trauma group（ ISS≤16,113）,moderate trauma group（ 16 〈ISS 〈25,47） and severe trauma group（ ISS≥25,70） according to the ISS scores. The level of plasma D-dimer and fibrinogen was measured and statistical analysis among different fracture sites and trauma severity were performed. Results Plasma D-dimer and fibrinogen level was significantly higher in traumatic group than in control group. There was significant difference between the two groups（ P〈0. 01）. The plasma D-dimer levels were significantly different among various fracture sites（ H = 104. 27,P〈0. 01）,of which from high to low were patients with multiple fractures,spine fracture,femoral fracture,tibia and fibula fracture,foot fracture,humeral fracture,ulna and radius fracture. The plasma fibrinogen levels were significantly different among various fracture sites（ H = 62. 84,P〈0. 01）,of which from high to low were patients with multiple fractures,spine fracture,femoral fracture,foot fracture,tibia and fibula fracture,humeral fracture,ulna and radius fracture. The increased severity of injury as seen by high ISS scores was correlated with higher D-dimer and fibrinogen level. There was significant difference among three trauma groups（ P〈0. 01）.Conclusion The levels of plasma D-dimer and fibrinogen in orthopedic trauma patients are significantly higher than in healthy individuals,they are closely related to fracture sites and increased with the severity of trauma. Thus,the D-dimer and fibrinogen level may be useful for initial evaluation of orthopedic trauma.