D-二聚体对消化道肿瘤患者术后深静脉血栓形成的预测价值

Predictive value of D-dimer for postoperative deep vein thrombosis in the patients with gastrointestinal cancer

目的 探讨D-二聚体对消化道肿瘤患者术后深静脉血栓形成的预测价值.方法 选取我院2017年11月~2018年11月消化道肿瘤手术患者97例,分别检测术前、手术当天及术后1 d的D-二聚体水平,并根据彩色多普勒超声检查结果将其分为DVT组(n=9)和非DVT组(n=88),同时选取我院健康体检者30例作为对照组,比较组内不同时间段及各组间的D-二聚体水平.结果 DVT组和非DVT组患者术前D-二聚体水平与对照组差异无统计学意义(P>0.05);DVT组和非DVT组患者手术当天、术后1 d D-二聚体水平明显高于对照组,差异有统计学意义(P<0.05);DVT组和非DVT组患者手术当天、术后1 d的D-二聚体水平明显高于术前,差异有统计学意义(P<0.05).ROC曲线分析显示术后1 d D-二聚体水平预测深静脉血栓形成较手术当天更准确,最佳临界值为4.23 mg/L时,灵敏度为87.5%,特异度为86.6%,曲线下面积为0.925.Logistic回归分析结果显示深静脉血栓形成与手术当天、术后1 d D-二聚体明显升高、Wells评分>1分、基础疾病呈正相关,与年龄、性别、是否腔镜手术相关性不明显.结论 D-二聚体水平对消化道肿瘤患者术后并发深静脉血栓形成的早期预测具有重要意义.

Objective To explore the predictive value of D-dimer for postoperative deep vein thrombosis in the patients with gastrointestinal cancer.Methods A total of 97 patients undergoing gastrointestinal cancer surgery in our hospital from November 2017 to November 2018 were selected.D-dimer levels were measured before surgery,on the day of surgery and one day after surgery respectively.According to the results of color Doppler ultrasound,the patients were divided into DVT group(n=9)and non-DVT group(n=88).At the same time,30 healthy subjects in our hospital were selected as the control group.D-dimer levels were compared in different time periods within groups and between groups.Results There was no statistically significant difference in D-dimer levels in the DVT group and non-DVT group before surgery compared with the control group(P>0.05).D-dimer levels were significantly higher on the day of surgery and one day after surgery in the DVT group and non-DVT group than in the control group,and the difference was statistically significant(P<0.05).The levels of D-dimer on the day of surgery and one day after surgery in the DVT group and non-DVT group were significantly higher than those before surgery,and the difference was statistically significant(P<0.05).ROC curve analysis showed that D-dimer level was more accurate in predicting deep vein thrombosis one day after surgery than on the day of surgery.The optimal critical value was 4.23 mg/L,the sensitivity was 87.5%,the specificity was 86.6%,and the area under the curve was 0.925.Logistic regression analysis showed that deep venous thrombosis was positively associated with D-dimer elevation on the day of surgery and one day after surgery,Wells score>1 point,and underlying disease,and was not significantly associated with age,gender,and procedures of laparoscopic surgery.Conclusion The D-dimer level is of great significance for the early prediction of postoperative complicated deep venous thrombosis in patients with gastrointestinal cancer.