凝血标志物对妇产科手术患者术后下肢深静脉血栓形成的诊断价值

Value of blood coagulation markers in the diagnosis of deep venous thrombosis of lower limbs in patients underwent gynecological surgery

目的探讨凝血标志物对妇产科手术患者术后下肢深静脉血栓形成(DVT)的诊断价值。方法选取2005年6月至2016年6月于洛阳市妇女儿童医疗保健中心接受妇产科手术患者156例,其中术后发生下肢DVT患者78例(观察组),术后未发生下肢DVT患者78例(对照组)。对2组患者血浆纤溶酶-抗纤溶酶复合物(PAP)、血栓调节蛋白(TM)、凝血酶-抗凝血酶复合物(TAT)、组织型纤溶酶原激活物(t-PA)、D-二聚体(D-D)水平进行比较,并通过受试者工作特征(ROC)曲线评估5种凝血标志物对下肢DVT的诊断价值。结果观察组患者血浆PAP、TM、t-PA及D-D水平显著高于对照组(P<0.05);2组患者血浆TAT水平比较差异无统计学意义(P>0.05)。血浆D-D的ROC曲线下面积最大,敏感度、特异度最好,其次为TM、t-PA和PAP。结论血浆PAP、TM、t-PA、D-D水平检测有助于妇产科手术后下肢DVT的早期诊断,其诊断价值自高至低依次为D-D、TM、t-PA和PAP。TAT由于受术后抗凝药物应用的影响,不适合应用于DVT的诊断。

Objective To investigate the value of blood coagulation markers in the diagnosis of deep venous thrombosis （DVT） of lower limbs in patients underwent gynecological surgery. Methods A total of 156 patients underwent gynecological surgery were selected from June 2005 to June 2016 in Luoyang Women and Child Health Care Center. Among them, there were 78 patients with DVT of lower limbs（observation group） and 78 patients without DVT lower limbs（ control group）. The levels of plasma plasmin-antiplasmin complex （PAP） , thrombomodulin （ TM ） , thrombin-antithrombin complex （TAT） , tissue plas- minogen activator （t-PA） and D-dimer （D-D） were compared between the two groups. The diagnostic value of the five blood coagulation markers in DVT of lower limbs was evaluated by receiver operating characteristic （ROC） curve. Results The levels of plasma PAP, TM, t-PA and D-D in the observation group were significantly higher than those in the control group （ P 〈 0. 05 ）. There was no significant difference in plasma TAT level between the two groups （ P 〉 0. 05 ）. The area under the ROC curve of plasma D-D was the largest, the sensitivity and specificity were the best, followed by TM, t-PA and PAP. Conclusion The detection of plasma PAP, TM, t-PA and D-D levels is helpful for early diagnosis of DVT of lower limbs after gynecologi- cal surgery;the diagnostic value from high to low in the order of D-D, TM,t-PA and PAP. TAT is not suitable for the diagnosis of DVT because of the influence of postoperative anticoagulant drugs.