TM、PIC、D-二聚体联合诊断骨外伤术后静脉血栓的价值分析

The Value of TM,PIC and D-dimer in the Diagnosis of Venous Thrombosis After Bone Trauma

目的探讨TM、PIC、D-二聚体在诊断骨外伤术后患者静脉血栓形成中的价值分析。方法选择2016年2月1日至2017年2月1日我院收治的创伤性四肢骨折患者96例作为研究对象,所有患者均接受骨折内固定手术。术后4～5d进行彩色多普勒结合静脉造影检查,诊断出术后静脉血栓形成患者48例,作为观察组,术后未出现静脉血栓形成患者48例,作为对照组。观察两组患者术后的血栓调节蛋白(TM)、纤溶酶-抗纤溶酶复合物(PIC)和D-二聚体。结果术后观察组患者的TM(9.12±2.09 IU/mL)、PIC(1.21±0.71μg/mL)和D-二聚体(5.37±2.14 ng/mL)含量均显著高于对照组TM(7.21±1.68IU/mL)、PIC(0.92±0.24μg/mL)和D-二聚体(2.34±0.66ng/mL),差异具有统计学意义(P<0.05)。回归分析显示D-二聚体、TM、PIC均与术后血栓的形成具有相关性(P均<0.05);三者联合诊断对静脉血栓诊断受试者工作曲线下面积为0.903,诊断灵敏度为87.31%,特异性也高达85.05%。三者联合检测的灵敏度87.31%高于TM、PIC和D-二聚体单一检测(22.96%、35.85%、49.79%)(P<0.05);三者联合检测的准确度86.39%高于TM、PIC和D-二聚体单一检测(49.38%、58.38%、72.27%)(P<0.05)。结论检测骨外伤患者术后TM、PIC、D-二聚体指标含量的变化,联合检测有助于早期诊断静脉血栓形成,对预警静脉血栓形成有重要价值。

Objective To explore the diagnostic value of TM, PIC and D-dimer in the formation of venous thrombosis after bone trauma. Methods A total of 96 patients with traumatic limb fractures admitted to our hospital from February 1,2016 to February 1,2017 were enrolled in this study. All patients underwent fracture fixation. After 4 -5d color doppler combined with intravenous contrast examination ,48 patients with diagnosis of postoperative venous thrombosis were divided as observation group, while no postoperative in 48 patients with venous thrombosis were divided as control group. The levels of thrombomodulin （TM）, plasminantipathase complex （PIC） and D-dimer were observed in both groups. Results The levels of TM （9.12 ± 2.09IU/mL）, PIC （ 1.21 ±0.71 μg/mL） and D- dimer （ 5.37 ± 2.14 ng/mL） were significantly higher in the patients in the postoperative group than those in the control group with TM（7.21 ± 1.68IU/mL）, PIC （0.92± 0. 24μg/mL） and D- dimer （ 2.34±0.66ng/mL ）, （ P 〈 0.05 ）. Regression analysis showed that D- two, TM and PIC were significantly correlated with postoperative thrombosis （ P 〈 0.05 ）. The combined diagnosis of three patients with venous thrombosis showed that the area under the diagnostic curve was 0.903, with the sensitivity of diagnosis 87.31%. The three combined detection had sensitivity higher than that of TM,PIC and D-two dimer single detection（22.96% ,35.85% ,49.79% ） （ P 〈 0.05 ） ;the three combined detection had accuracy 86. 39%, which was higher than that of TM, PIC and D-two dimer single test （49.38% ,58.38% ,72.27% ） （ P 〈 0.05 ）. Conclusion The level changes of TM, PIC and D-dimer in patients with bone trauma were useful to diagnose venous thrombosis and have important value in the prevention of venous thrombosis.