血小板计数与血红蛋白比值和血糖变化对合并颅脑创伤的多发伤患者下肢深静脉血栓形成的预测价值

Predictive value of blood platelet/hemoglobin and glucose for lower deep venous thrombosis following multiple trauma in combination with traumatic brain injury

目的探讨合并颅脑创伤的多发伤患者血小板计数与血红蛋白比值、血糖水平和凝血相关实验室指标变化与下肢深静脉血栓形成(DVT)的关系。方法选择2016年1—12月上海交通大学附属第六人民医院急诊创伤中心接诊的合并颅脑创伤的多发伤患者118例,经血管彩色多普勒超声检查有DVT(DVT组)45例(38.1%),无DVT(无DVT组)73例(61.9%)。于伤后4d抽取患者静脉血,测定并比较两组血小板计数、血红蛋白和血糖水平,以及凝血酶原时间(PT)、国际标准化比率(INR)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、抗凝血酶(AT)Ⅲ活性,以及纤维蛋白原(FIB)、D-二聚体、纤维蛋白原降解产物(FDP)水平。采用多因素Logistic回归分析合并颅脑创伤的多发伤患者下肢DVT的独立危险因素,绘制相关独立危险因素的ROC曲线。结果 DVT组的血小板计数/血红蛋白比值和血糖、D-二聚体、FDP水平均显著高于无DVT组(P值分别<0.01、0.05),TT显著长于无DVT组(P<0.05);两组间血小板计数、PT、INR、APTT、FIB、ATⅢ活性的差异均无统计学意义(P值均>0.05)。多因素Logistic分析结果显示,血小板计数/血红蛋白比值(OR=1.699,95%CI为1.125～2.567)和血糖水平(OR=1.309,95%CI为1.040～1.647)是合并颅脑创伤的多发伤患者下肢DVT的独立危险因素(P值均<0.05)。血小板计数/血红蛋白比值和血糖水平的最佳界值分别为1.7×10~9/g和8.3mmol/L时预测下肢DVT的敏感度和特异度分别为0.73和0.70,当血小板计数/血红蛋白比值>1.7×10~9/g和血糖水平>8.3mmol/L时,下肢DVT的发生率为72.9%(86/118)。结论合并颅脑创伤的多发伤患者下肢DVT的发生率较高,血小板计数/血红蛋白比值和血糖水平是下肢DVT的独立危险因素,对此类疾病具有预测价值。

Objective To explore the relationship between the deep venous thrombosis （DVT） of the lower extremities and the variation of relevant laboratory indexes such as the ratio of blood platelet to hemoglobin （PLT/Hb）, glucose （GLU） , blood coagulation parameters in patients with multiple trauma accompanied with traumatic brain injury. Methods A total of 118 patients with multiple trauma accompanied with traumatic brain injury admitted to trauma emergency center of Shanghai Sixth People＇ s Hospital between January 2016 and December 2016 were enrolled in this study. DVT was found in 45 patients （38. 1%） and not in 73 patients （61.9%） by vascular ultrasound. Venous blood was collected on day 4 after surgery in all the patients. Relevant parameters including PLT, Hb, GLU , prothrombin time （PT）, international normalization ratio （INR）, activated partial thromboplastin time （APTT）, thrombin time （TT）, antithrombin Ⅲ （ATⅢ）, fibrinogen （FIB）, D-dimer and fibrinogen degradation product （FDP） were detected and compared between patients with and without DVT. Multivariate logistic regression analysis was used to identify independent risk factors of DVT of lower extremities in these patients and receiver operating characteristic （ROO） curve was drawn. Results Patients with DVT had higher levels of PLT/Hb, GLU, D-dimer and FDP and longer TT than those without DVT （P〈0.01 or 0.05）. But there were no statistical differences in PLT, PT, INR, APPT, FIB or ATⅢ between the patients with and without DVT （all P〉0.05）. IVlultivariate logistic regression analysis revealed that PLT/Hb （OR= 1.699, 95%CI ： 1. 125-2. 567） and GLU （ OR = 1. 309, 95% CI ： 1. 040 - 1. 647） were the independent risk factors of DVT of lower extremities in patients with multiple trauma accompanied with traumatic brain injury （both P〈0. 05）. When the cutoff value of PLT/Hb and GLU were 1.7 × 10^9/g and 8.3 mmol/L, the sensibility and specificity for the prediction of DVT were 0.73 and 0.70, respectively. The incidence of lower DVT was 72.9 % （86/118） when both indexes were greater than the cutoff value. Conclusion There is a higher incidence of lower DVT in patients with multiple trauma in combination with traumatic brain injury. PLT/Hb and GLU are the independent factors influencing the formation of lower DVT and could be predictors in diagnosis.