纤维蛋白单体和D-二聚体联合检测在老年髋部骨折患者术后深静脉血栓形成中的预测价值

The role of combined detection of fibrin monomer and D-dimer in predicting postoperative deep venous thrombosis in elderly patients with hip fracture

目的探讨纤维蛋白单体(FM)和D-二聚体(D-D)联合检测在老年髋部骨折患者术后深静脉血栓(DVT)形成中的预测价值。方法 选择2015年1月—2017年12月四川省简阳市人民医院骨二科诊治的170例老年髋部骨折患者作为观察组,根据影像学检查结果分为血栓亚组32例和非血栓亚组148例,分别于术前1d,术后3d、7d、14d检测D-D和FM水平。另选择同期于医院健康体检者150例作为健康对照组,亦行D-D和FM检测。通过受试者工作曲线下面积(AUC)评价D-D、FM单独及联合检测对DVT形成的预测价值。结果 非血栓亚组、血栓亚组D-D水平于术前1d均高于健康对照组(P<0.05),血栓亚组术前1d及术后各时点均高于非血栓亚组,FM水平于术后各时点均高于健康对照组和非血栓亚组(t/P=6.925/0.000、10.874/0.000、8.271/0.000、13.039/0.000、3.659/0.012、3.797/0.008、5.038/0.000);D-D诊断DVT的截值为9.55mg/L,FM诊断DVT的截值为20.54mg/L,D-D联合FM预测DVT的敏感度及特异度分别为90.80%和76.00%,高于FM和D-D单独预测的敏感度及特异度,差异均有统计学意义(P<0.05)。结论 纤维蛋白单体和D-二聚体联合检测具有较高的诊断敏感度和特异度,可在深静脉血栓早期进行诊断,具有较高的预测价值。

Objective To investigate the predictive value of combined detection of fibrin monomer and D-dimer in deep venous thrombosis (DVT) in elderly patients with hip fracture. Methods A total of 170 elderly patients with hip fractures who were treated in Department of Orthopaedics, Jianyang People's Hospital from Janurary 2015 to December 2017 were enrolled. The D-dimer levels were measured at 1 day before surgery, 3 days, 7 days, and 14 days after surgery (D-D). And plasma fibrin monomer level (FM), and confirmed by impact test, according to the results of the test were divided into thrombus group and non-thrombotic group. A total of 150 healthy subjects in our hospital were selected as the control group for D-D and FM detection. The predictive value of D-D and FM combined detection for DVT formation was evaluated by the area under the receiver's working curve. Results There were significant differences in the levels of D-D between the thrombus group and the non-thrombotic group 1d, 3d, 7d and 14d after operation ( t/P =6.925/0.000,10.874/0.000,8.271/0.000,13.039/0.000). The differences in FM levels between the thrombus group and the non-thrombotic group at 3d, 7d and 14d were statistically significant( t/P =3.659/ 0.012 ,3.797/0.008,5.038/0.000).The cutoff value of D-Dwas 9.55 mg/L,the cutoff value of FM was 20.54 mg/L. The sensitivity of D-D combined with FM detection was 90.80%, which was higher than the sensitivity of FM detection and D-D detection( P <0.05);the specificity of D-D combined with FM detection was 76.00%, higher than the sensitivity,specificity of FM detection and D-D detection( P <0.05). Conclusion The combination of fibrin monomer and D-dimer has high diagnostic sensitivity and specificity. It can be diagnosed early in deep vein thrombosis and has high predictive value.