下肢骨折术后Fib、D-二聚体检测的意义及其在术后深静脉血栓形成中的预测价值

Significance of the detection of Fib and D-dimer in postoperative lower limb fractures and to explore its predictive value in postoperative deep vein thrombosis

目的分析Fib、D-二聚体在下肢骨折术后检测的意义,探究其在术后深静脉血栓形成中的预测价值。方法选择2017年3月至2018年5月在我院接受下肢骨折术的84例患者,分别在术前及术后行下肢彩色多普勒超声检查,以阳性结果作为深静脉血栓的诊断标准,分为DVT组和非DVT组;选取同时期26例体检的健康者设置为对照组。分别于术前、术后3 d、术后7 d检查所有研究对象血浆D-二聚体、Fib水平,比较三组检测结果,探讨血浆Fib、D-二聚体作为快速简便诊断试验的真实性和预测值。结果术前DVT组患者血浆D-二聚体和Fib水平高于对照组; DVT组术后血浆D-二聚体和Fib水平较术前明显升高,且高于非DVT组。血浆D-二聚体水平作为筛检标准,其灵敏度、特异度、阳性预测值和阴性预测值分别为81. 3%、85. 3%、0. 57、0. 95;血浆Fib浓度作为筛检标准,其灵敏度、特异度、阳性预测值和阴性预测值分别为62. 5%、88. 2%、0. 55、0. 91; D-二聚体联合Fib作为筛检标准,其灵敏度、特异度、阳性预测值和阴性预测值分别为93. 8%、91. 2%、0. 71、0. 98; D-二聚体/Fib联合检测不仅真阳性率高于单独检测,且其漏诊率(1-真阳性率)也显著降低。结论血浆D-二聚体、Fib检测对下肢骨折术后并发深静脉血栓的早期诊断、预防具有重要临床意义,且联合检测血清D-二聚体、Fib水平能够提高DVT早期诊断灵敏度,降低漏诊率,具有重要的临床价值。

Objective To analyze the significance of the detection of Fib and D-dimer in postoperative lower limb fractures and to explore its predictive value in postoperative deep vein thrombosis.Methods A total of84patients who received lower limb fracture surgery in our hospital from March2017to May2018were selected and received lower limb color doppler ultrasonography before and after surgery Respectively.Positive results were used as the diagnostic criteria for deep vein thrombosis,and these patients were divided into DVT group and non-DVT group.Another26healthy people who had physical examination in the same period were selected as the control group.Plasma D-dimer and Fib levels of all the subjects were examined before and at3d and7d after operation,and the test results of the three groups were compared to explore the authenticity and predictive value of plasma Fib and D-dimer as rapid and simple diagnostic tests.Results The plasma D-dimer and Fib concentrations after surgery in DVT group were higher than those in control group.The plasma D-dimer and Fib concentrations in DVT group were higher than those before surgery,and plasma D-dimer and Fib in DVT group were significantly higher than those in non-DVT group at different time points;the plasma D-dimer level was used as the screening standard,and the sensitivity,specificity,positive predictive value and negative predictive value were81.3%,85.3%,0.57and0.95;plasma Fib level was used as the screening standard,and the sensitivity,specificity,positive predictive value and negative predictive value were62.5%,88.2%,0.55and0.91;D-dimer combined with Fib was used as screening standard,and sensitivity,specificity,the positive predictive value and negative predictive value were93.8%,91.2%,0.71and0.98.The D-dimer/Fib combined test not only had a higher true positive rate than the single test,but the missed diagnostic rate(1-true positive rate)was also significantly lower.Conclusion Plasma D-dimer and Fib detection are of important clinical significance for the early diagnosis and prevention of deep vein thrombosis after lower limb fracture surgery,and combined detection of serum D-dimer and Fib can improve the early diagnosis sensitivity of DVT and reduce the rate of missed diagnosis,which is of great clinical value.