血浆D-二聚体在高龄男性冠心病患者合并急性静脉血栓形成时的变化及临床意义

The the changes and clinical significance of peripheral blood D-dimer in acute venous thrombosis in elderly male patients with coronary heart disease

目的研究血浆D-二聚体(DD)在高龄男性冠心病患者合并急性静脉血栓形成时的变化及临床意义。方法收集2015年1月-2019年1在解放军总医院第七医学中心干部病房住院的高龄男性冠心病患者142例,按照有无合并静脉血栓分为2组,合并静脉血栓者70例为血栓组(其中急性下肢静脉栓塞亚组19例,急性肺栓塞亚组21例),未合并静脉血栓者72例为对照组,比较2组患者的血浆DD水平及相关凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶时间(APTT)与纤维蛋白原(Fib)的变化,并分析血浆DD水平与凝血指标的相关性及其诊断价值。结果血栓组患者血浆DD含量、Fib明显高于对照组(t=13.897,3.973,P<0.01),PT、TT、APTT明显低于对照组(t=3.659,3.797,8.271,P<0.01);急性下肢静脉栓塞亚组和急性肺栓塞亚组血浆DD水平及相关凝血指标比较差异无统计学意义(P> 0.05)。采用Pearson相关性分析发现,DD值与Fib呈正相关(r=0.896,P=0.000),DD值与PT、TT、APTT呈负相关(r=-0.463、-0.498、-0.536,P=0.012、0.016、0.001)。血浆DD预测静脉栓塞的ROC曲线下面积为0.939,血浆DD截断值为1.81 mg/L。结论检测高龄男性冠心病患者的血浆DD和凝血功能,可及时发现是否处于高凝状态,预测静脉血栓形成,以便及时加强抗凝治疗,减少急性事件发生。

Objective To sludy the changes and celinical significance of peripheral blood D-dimer(DD) in acute venous thrombosis in elderly patients with coronary heart disease(CHD).Methods From January 2015 to January 2019,142 elderly patients with coronary heart disease who were hospitalized in the cadre ward of the 7 th Medical Center of the People’s Liberation Army General Hospital were selected.The patients were divided into 2 groups according to the presence or absence of acute venous embolism and acute pulmonary embolism.70 patients with venous thrombosis were the thrombus group(there were 19 cases of acute venous embolism and 21 cases of acute pulmonary embolism),and 72 patients without venous thrombosis were the control group.The plasma DD level and the related prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT) and fibrinogen(Fib) were compared between the two groups.The correlation between plasma DD level and coagulation index and its diagnostic value were analyzed.Results The plasma DD and FIb were significantly higher in thrombosis group than in control group(t=13.897,3.973,P<0.01).PT,TT and APTT were significantly lower in thrombosis group than in control group(t=3.659,3.797,8.271,P <0.05).There was no significant difference in the levels of DD and related coagulation indexes between the two groups(P> 0.05).The area under ROC curve of plasma DD was 0.939,and the critical value of plasma DD was≥1.81 mg/L.Conclusion Detection of plasma DD and coagulation in elderly male patients with coronary heart disease can find out whether they are in hypercoagulable state in time and predict venous thrombosis,so as to strengthen anticoagulation therapy in time and reduce the occurrence of acute events.